One of the primary treatments for men with prostate cancer has been hormone therapy. Hormone therapy also known as androgen deprivation therapy (ADT) is used to reduce levels of the male hormones called androgens produced in the body. In order for prostate cancer cells to grow they rely on the male sex hormones or androgens. ADT will stop or suppress the production of androgens cutting their ability to bind to specific receptors which thus stops the spread and growth cancer cells.
However, a new study at Yale Cancer Center, reports that ADT may do more harm than good in men who have previously suffered a heart attack.
Using a decision analysis model, researchers looked at a previous study comparing quality-adjusted life expectancy (QALE) in men age 50, 60, and 70. These men had received radiation therapy for high-risk prostate cancer and stratified by cardiac risk.
The data analyzed was from the recently published EORTC 22991 trial – this included 819 men with intermediate-risk (74.8%) and high-risk (24.8%) prostate cancer with an average age of 70. The patients were randomly assigned wither to receive radiation therapy (409 men) or radiation therapy plus six months of hormone therapy (410 men).
Follow-up of the men was done eight years later and what was found was that men who had a history of heart attack and were treated with hormone therapy had decreases of 0.3 to 0.4 in their quality-adjusted life expectancy. The men who did not have a history of heart attack had improved quality-adjusted life expectancy with a range of 0.4-2.6.
Men who were younger and did not have a cardiac history or few risk factors associated with it, had the most benefit from ADT.
These are considerations all doctors who work with men and prostate cancer should consider – the age of each patient, their risk for cardiovascular disease and if they have ever had a heart attack.