Men with previous illnesses don't benefit from combined prostate cancer therapy, study says

Adding hormone treatment to radiation therapy does not improve survival chances for prostate cancer patients who already have other illnesses when their treatment begins, a new analysis by Boston researchers shows.

Dr. Anthony V. D'Amico of Brigham and Women's Hospital and his colleagues went back to a 2004 study of hormone treatment in prostate cancer patients to compare subgroups of men whose health was different before treatment. They report their findings in the current Journal of the American Medical Association.

“There is some clinical interaction, almost like a drug interaction, between the hormone therapy and the underlying illness, particularly cardiovascular disease,” D’Amico said in an interview. “This is the strongest piece of evidence to date for looking into hormone therapy and shorter survival time for men with cardiovascular disease.”

The researchers followed 206 men who had an average age of 72 for seven years. Adding hormone therapy to radiation increased survival overall among the men, with 44 deaths among men who got radiation alone compared to 30 deaths in men who got both therapies.

Among the 157 men with no previous illness or moderate illness, there were 31 deaths in the radiation-only group vs. 11 deaths in the combined therapy groups. But for the 49 men who had a moderate or severe illness, the survival rate was reversed: There were 13 deaths among men who received only radiation compared to 19 deaths of men who had both treatments.

D’Amico said the findings should spur doctors to evaluate patients with a history of heart problems, smoking, or diabetes before they begin prostate cancer treatment. The men could be treated for any problems that tests turned up, such as any blockages in coronary arteries, before starting cancer therapy, he said.

The difference in death rates appeared to be stronger in men who had had heart attacks at least six months before starting cancer therapy, but the numbers were too small to rule out other illnesses such as diabetes, he said.

The study’s results are in keeping with concerns about hormone therapy’s side effects, Dr. Vahakn Shahinian of the University of Michigan said in an interview, citing studies that tied androgen deprivation with later cardiovascular disease.