Hormone therapy riskier in sicker men
Heart patients with prostate cancer may not benefit
CHICAGO - A new study links hormone therapy for prostate cancer with a higher risk of death in older men who have had serious heart problems.
Hormone therapy suppresses the amount of testosterone produced, in turn causing prostate tumors to shrink or grow more slowly. The treatment, involving injections in a doctor’s office, can help men with more advanced disease when used with surgery or radiation.
But the side effects are troubling: impotence, bone loss, hot flashes, memory problems, fatigue, and an increased risk for diabetes and heart disease.
For the new study, appearing in today’s Journal of the American Medical Association, researchers followed more than 5,000 men with prostate cancer that had not spread. The men, most in their 60s and 70s, were followed an average of five years.
All the patients had brachytherapy, a type of radiation treatment, at one Illinois treatment center. Thirty percent of them also took hormone therapy for an average of four months.
Five percent of the men in the study had a history of heart failure or heart attack, and 43 of those men died. Among those with heart problems, the hormone treatment was linked with a 96 percent higher risk of death after adjusting for other risk factors.
In raw numbers, of the 95 men on hormone therapy who also had a history of serious heart problems, 25 died; and of the 161 men not on hormone therapy who also had a history of heart problems, 18 died.
“Our results should heighten awareness about the potential for harm with hormonal therapy for men with preexisting heart disease,’’ said lead author Dr. Akash Nanda of the Harvard Radiation Oncology Program.
The study was observational, meaning the men chose their treatment with their doctors, rather than being randomly assigned to get one treatment or another. That is a less rigorous approach and means the deaths could have been caused by factors other than the hormone therapy.
But the findings line up with prior studies that have found that sicker men don’t benefit from hormone therapy when it is added to radiation. And hormone therapy used alone in older men has been linked to a slightly heightened risk of death.
The study was funded by Brigham and Women’s Hospital and the Dana-Farber Cancer Institute.