Hormone Therapy & Cardiac Risk

Hormone therapy for prostate cancer, also called androgen deprivation therapy (ADT), is often used when the cancer has spread too far within the body or if surgery or radiation has not been effective. It may also be used prior to radiation to reduce the size of the tumor, or in addition to radiation if the Gleason score indicates there is a likely possibility the cancer may return after initial treatment. But doctors may start re-thinking how often they draw upon ADT following a report that men who received it for prostate cancer suffered a net harm if they had a prior history of a heart attack.

“Patient age, cardiac risk, and disease recurrence risk should be considered when selecting candidates for hormone therapy in this patient population,” said Nataniel Lester-Coll, MD, first author on the study and a Resident in the Department of Therapeutic Radiology at Yale School of Medicine. “Men with a history of heart attack who are at very low risk for biochemical failure may be harmed by the addition of hormone therapy.”

Lester-Coll's work incorporated data from a previously published decision analysis model that compared quality-adjusted life years in men aged 50, 60, and 70 years who received radiation therapy and no hormone therapy for high-risk prostate cancer and their cardiac risk factors. The researchers also used the results of a phase III study that compared 6 months of androgen suppression and irradiation versus irradiation alone for intermediate-risk prostate cancer.

The results showed that hormone therapy netted patients a decrease of 0.3 to 0.4 quality-adjusted life years in men who had a previous history of cardiac arrest.  For everyone else, ADT improved quality-adjusted life years by a range of 0.4 to 0.6. The younger the patient with the fewer incidents of cardiac risk factors, the larger the benefit received from hormone therapy. Moreover, patients at low risk for biochemical failure did not benefit from hormone therapy. Overall, no patient saw any benefits from hormone therapy until after 7.3 years of follow-up.

The research was presented at the recent American Society for Therapeutic Radiology and Oncology meeting in Boston.