Hormone Therapy for Prostate Cancer Patients With Heart Disease May Increase Mortality
Reported August 28, 2009
(Ivanhoe Newswire) — Men with congestive heart failure or heart attack who receive both hormone therapy and radiation therapy for treatment of prostate cancer have an increased risk of death, according to a new study.
Patients with localized prostate cancer have several treatment options, including brachytherapy, in which radioactive seeds are implanted in the prostate. Brachytherapy can be used alone or in conjunction with external beam radiation therapy. Previous research has suggested that “hormonal therapy (HT) when added to radiation therapy (RT) for treating unfavorable-risk prostate cancer leads to an increase in survival except possibly in men with moderate to severe comorbidity [co-existing illnesses]. However, it is unknown which comorbid conditions eliminate this survival benefit,” the authors wrote.
Akash Nanda, M.D., Ph.D., of Brigham & Women’s HospitalDana-Farber Cancer Institute, Boston, and colleagues assessed whether HT use in prostate cancer patients who were treated with brachytherapy affects the risk of death in those with known coronary artery disease. The study included 5,077 men, median age, 69.5 years, with localized or locally advanced prostate cancer who were treated with HT followed by RT between 1997 and 2006 and were followed up until July 2008.
During the study period, 419 men died. Of those, 200 had no underlying comorbidity, 176 had one coronary artery disease risk factor, and 43 had a history of known coronary artery disease resulting in congestive heart failure or heart attack. The data indicated that “when considering comorbidity groups separately, neoadjuvant HT use was not associated with an increased risk of all-cause mortality in men with no comorbidity . . . or a single coronary artery disease risk factor . . . after median follow-ups of 5.0 years and 4.4 years, respectively,” the researchers wrote.
However, for men with congestive heart failure or heart attack, after a median follow-up of 5.1 years, HT use was associated with nearly twice the risk of all-cause mortality.
“It is also important to note that the population of men in whom the use of neoadjuvant HT may be detrimental was limited to 5 percent (256 of 5,077) in this community-based study cohort. This latter point may explain why there has been a survival benefit observed in the major randomized trials comparing HT plus external beam radiation therapy to external beam radiation therapy alone,” the authors wrote.
“The clinical significance of this finding,” the authors concluded, “is that for men with favorable-risk prostate cancer and a history of congestive heart failure or myocardial infarction who require neoadjuvant HT solely to eliminate pubic arch interference, alternative strategies such as active surveillance or treatment with external beam radiation therapy or prostatectomy should be considered.”
SOURCE: Journal of the American Medical Association (JAMA), August 26, 2009