Analysis found men with heart disease might live longer when treated with radiation alone
(HealthDay News) — Men with prostate cancer who also have had a heart attack may fare better with radiation therapy alone rather than with the standard treatment of radiation plus hormone therapy, a new analysis suggests.
Over an average of 17 years of follow-up, men with high-risk prostate cancer who also had a heart condition lived longer after radiation treatment alone than similar men who had radiation and hormone therapy. Men who didn’t have heart problems lived longer if they had both treatments, the researchers added.
“There have been several trials looking at radiation with or without hormone therapy in high-risk prostate cancer which found a survival benefit from combined treatment,” said lead researcher Dr. Anthony D’Amico, chief of radiation oncology at Brigham and Women’s Hospital in Boston.
Hormone therapy is also called androgen deprivation therapy (ADT) or androgen suppression therapy. The goal is to reduce levels of male hormones, called androgens, in the body, or to stop them from affecting prostate cancer cells.
The main androgens are testosterone and dihydrotestosterone (DHT). Most of the body’s androgens come from the testicles, but the adrenal glands also make a small amount. Androgens stimulate prostate cancer cells to grow. Lowering androgen levels or stopping them from getting into prostate cancer cells often makes prostate cancers shrink or grow more slowly for a time. But hormone therapy alone does not cure prostate cancer, according to the American Cancer Society.
Prostate cancer is the leading cause of cancer cases and the second-leading cause of cancer deaths among African-American men behind lung and bronchus cancer, according to the American Cancer Society’s “2013-2014 Cancer Facts & Figures for African Americans.”
However, whether hormone therapy causes an increase in death from heart problems has been controversial, D’Amico he said. Several studies have not found a difference in survival.
D’Amico and his colleagues looked specifically at men who had other medical problems in addition to high-risk prostate cancer — particularly at men who had suffered a heart attack.
High-risk prostate cancer is cancer that is confined to the prostate but likely to spread to other parts of the body.
“We found that there was no survival benefit to adding hormones to men who had had a heart attack,” D’Amico said. “In fact, they died sooner.”
The main cause of death was a fatal heart attack, he said.
“We know hormone therapy causes a variety of problems, including raised blood pressure and raised blood sugar,” D’Amico explained.
Because this study analyzed data from a completed trial, D’Amico said it doesn’t prove hormone therapy caused heart attacks. “It’s an association, it’s not proof,” he said. “But there is a good likelihood that it’s true,” he added.
D’Amico suggested that men who have had a heart attack but need hormone therapy should get their cardiologist involved to make sure their heart disease is controlled.
“We don’t withhold hormone therapy in men with heart disease, but we do want a cardiologist to make sure everything is managed,” D’Amico said.
The report was published as a research letter in the Sept. 22/29 issue of the Journal of the American Medical Association.
For the study, the researchers looked at outcomes of 206 men with high-risk prostate cancer who were randomly selected to get six months of both radiation and hormone therapy or radiation therapy alone. The men were selected between December 1995 and April 2001. Six months of hormone therapy and radiation therapy is the standard treatment for high-risk prostate cancer.
The investigators found that hormone therapy was not associated with overall survival over the first eight years of the study. Over the course of 17 years, however, there was no survival benefit from hormone therapy, they added.
Dr. Louis Potters, chair of the department of radiation medicine at North Shore-LIJ Health System in Great Neck, N.Y., said, “There has always been this underlying fear that manipulating hormones is going to have an effect on the heart in patients at risk for heart disease.”
Potters added that this study won’t change clinical practice, but it may cause doctors to question if men with heart disease will benefit from hormone therapy.
“For men with high-risk prostate cancer, it is important for them to take into account their overall health and underlying medical conditions in determining the best treatment for their prostate cancer,” Potters said.
Radiation therapy alone is still an effective treatment for prostate cancer, he added.
“Someone at risk for heart disease or with existing heart disease might think twice about hormone therapy,” he said. “You are still going to get treatment, just not the benefit of adding hormone therapy.”