CV disease history may be contraindication for prostate cancer therapy
MedWire News: The use of hormone therapy (HT) may increase mortality risk in prostate cancer patients with a history of coronary artery disease (CAD)–induced congestive heart failure (CHF) or myocardial infarction (MI), US study results suggest.
While the investigators say the findings “should heighten awareness about the potential for harm with neoadjuvant HT use in select men,” they also acknowledge that this group made up only 5% of their community based sample.
Combined use of HT with external beam radiation therapy (RT) has resulted in improvements in both cancer-specific and overall survival compared with RT alone in men with locally advanced or localized, unfavorable-risk prostate cancer.
There have, however, been concerns about the risk for adverse effects including the development of insulin resistance and unfavorable lipid profiles, a decrease in muscle mass and bone mineral density, and an increased risk for cardiovascular (CV) death.
Focusing on CV parameters, Akash Nanda (Dana-Farber Cancer Institute, Boston, Massachusetts) and colleagues retrospectively examined the records of 5077 men (median age 69.5 years) with prostate cancer who were treated with or without neoadjuvant HT followed by external RT at a suburban cancer center between 1997 and 2006.
Following up the sample in 2008, the researchers report in the Journal of the American Medical Association that a total of 419 men had died of any cause. Of those men, 200 had no underlying comorbidity, 176 had one CAD risk factor, and 43 had a history of known CAD resulting in CHF or MI.
For the entire cohort, neoadjuvant HT plus RT use did not carry an increased risk for all-cause mortality (hazard ratio [HR]=1.08).
When considering comorbidity groups separately, neoadjuvant HT use was not associated with an increased risk for all-cause mortality in men with no comorbidity (HR=0.97) or a single CAD risk factor (HR=1.04).
However, for men with CAD–induced CHF or MI, neoadjuvant HT use was significantly associated with an increased risk for all-cause mortality (HR=1.96).
Discussing the practical implications of these finding Nanda et al comment: “For men with favorable-risk prostate cancer and a history of congestive heart failure or myocardial infarction, alternative strategies such as active surveillance or treatment with external beam RT or prostatectomy should be considered.
“However, for men with unfavorable risk prostate cancer who require HT in addition to RT to take advantage of its survival benefit, appropriate medical evaluation prior to initiation should facilitate clinicians in balancing the relative risks.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
By Andrew Czyzewski