A new US study found that prostate cancer patients with certain heart conditions who received hormone therapy either before or with radiation therapy were at higher risk of death than equivalent patients who did not have hormone therapy. The study showed that the risk of death nearly doubled for men with coronary artery disease-induced congestive heart failure or heart attack when they received hormone therapy in addition to radiation therapy.
The research was done by Akash Nanda of Brigham & Women’s Hospital-Dana-Farber Cancer Institute, in Boston, Massachusetts, and colleagues, and appears online in the 26 August issue of JAMA, Journal of the American Medical Association.
Other studies have already shown that adding hormone therapy to radiation therapy treatment for prostate cancer in men with lower survival prospects can increase survival rates, unless the men also have other moderate to severe health conditions. However, what has not been clear is what these conditions are and the effect they have either individually or together.
For this study, Nanda and colleagues examined 5,077 men of median age 69.5 years who had localized or locally advanced prostate cancer and were treated at one clinic between 1997 and 2006. They were followed up until July 2008.
All of the patients had received brachytherapy, a type of radiation therapy, and just under one third of them had also received “neoadjuvant” hormone therapy for a median of 4 months. Neoadjuvant in this context means that the hormone therapy was given either just before or at the same time as the radiation treatment.
The results showed that:
- 419 of the men died during the study period.
- Of these, 200 had no other health conditions (comorbidities), 176 had one coronary artery disease risk factor, and 43 had a history of coronary artery disease that had led to congestive heart failure or heart attack.
- Neoadjuvant hormone therapy use was not linked to increased risk of death from all causes in men who had no other health problems (9.6 per cent vs 6.7 per cent after 5.0 years of follow up).
- There was also no increased risk in men who had a single coronary artery disease risk factor (10.7 vs 7.0 per cent after 4.4 years of follow up).
- However, for men with coronary artery disease (CAD)-induced congestive heart failure (CHF) or heart attack (myocardial infarction, MI), after a median follow up of 5.1 years, neoadjuvant hormone therapy (HT) was linked to nearly twice the risk of death from all causes (26.3 vs 11.2 per cent).
The researchers concluded that:
“Neoadjuvant HT use is significantly associated with an increased risk of all-cause mortality among men with a history of CAD-induced CHF or MI but not among men with no comorbidity or a single CAD risk factor.”
The authors wrote that the clinical significance of this finding is that:
“For men with favorable-risk prostate cancer and a history of congestive heart failure or myocardial infarction who require neoadjuvant HT solely to eliminate pubic arch interference, alternative strategies such as active surveillance or treatment with external beam radiation therapy or prostatectomy should be considered.”
However:
“For men with unfavorable-risk prostate cancer who require HT in addition to radiation therapy to take advantage of its survival benefit, appropriate medical evaluation prior to initiation should facilitate clinicians in balancing the relative risks against the benefits of HT use,” wrote the authors.
“Hormonal Therapy Use for Prostate Cancer and Mortality in Men With Coronary Artery Disease-Induced Congestive Heart Failure or Myocardial Infarction.”
Akash Nanda; Ming-Hui Chen; Michelle H. Braccioforte; Brian J. Moran; Anthony V. D’Amico.
Additional source: JAMA Archives.
Written by: Catharine Paddock, PhD