According to specialists' warnings published in Heart, it has been established that androgen suppression therapy (AST) drugs, that suppress testosterone production for the treatment of prostate cancer, can lead to complications in form of stroke and heart disease, yet standard management of the disease ignores this risk.
According to the authors, AST is the primary treatment for advanced prostate cancer and is evidently very efficient, however, mounting evidence indicates that these drugs also substantially raise the risk of heart disease and stroke, and may also be linked to a higher risk of mortality from these causes, the authors add referring to evidence of various published research.
They say that since the introduction of prostate specific antigen (PSA) tests, the number of men who have been started on AST at an earlier stage has risen significantly and will continue to do so. Other side effects of hormone suppression include thinning of the bones, a higher risk of fractures fatigue and less muscle function.
The authors state that even though it remains unclear whether there is a direct causal association between these drugs and cardiovascular disease, there are definitely plausible explanations for the impact these drugs have on increasing the risks for stroke and heart disease. This is a fact that has not been overlooked by various initiatives, such as the American Heart Association, the American Cancer Society, and the American Urological Association, who have issued a joint statement to this effect.
The authors point out that one study estimates that for every 1,000 men who underwent AST therapy for five years the result will be an additional 360 extra cases of diabetes, 315 cases of heart disease, 42 more strokes and 28 additional heart attacks, which equates to £700 million to £2 billion ($1.1 billion to $3 billion) in NHS (National Health Service, UK) costs between 2004 and 2009 alone.
"The concept of incorporating cardiovascular disease management into AST as standard has not yet percolated into clinical practice."
They add that due to the fact that cancer and heart disease are managed separately, there is hardly any coordination between doctors. Current guidelines on prostate cancer have not accounted for management of cardiovascular disease and neither do they clarify who should be taking the lead they write, stating:
"Presently, we are unaware of any current local or national management plans that attempt to address the increased risk of cardiovascular disease associated with androgen suppressant therapy or recognize these men in screening procedures."
"The current status quo of no action is, in our view, unsatisfactory for the patient and unlikely to be cost effective," and continue suggesting that the solution of the problem may be cancer nurse specialists, who are highly efficient and relatively cost-effective.
Written by: Grace Rattue