Androgen-deprivation therapy (ADT) has been shown to improve overall survival for men with high-risk prostate cancer, but the treatment appears to carry a heightened risk of death for men with such disease as well as a history of heart failure (HF) or myocardial infarction (MI).
The project yielding this finding involved 14,594 men with cT1c-T3aN0M0 prostate cancer who were treated with brachytherapy-based radiation therapy at some point between 1991 and 2006. A total of 1,378 (9.4%) had a history of HF or MI.
Of the men with the heart conditions (median age 71.8 years), 22.6% underwent supplemental external beam radiation therapy, and 42.9% received neoadjuvant ADT for a median of 4 months.
Over a median follow-up period of 4.3 years, ADT was associated with a significantly increased risk of all-cause mortality, with 5-year estimates of 22.71% with the hormone therapy and 11.62% without.
“We found that for men with localized prostate cancer and a history of heart problems, treatment with hormones plus radiation was associated with a higher all-cause mortality than treatment with radiation alone, even for patients with high-risk malignant disease,” affirmed study lead author Paul L. Nguyen, MD, a radiation oncologist at the Dana-Farber/Brigham and Women’s Cancer Center in Boston, Massachusetts, in a statement describing his group’s findings, which were published online by the International Journal of Radiation Oncology*Biology*Physics. “Despite Phase 3 data supporting hormone therapy use for men with high-risk disease, the subgroup of men with a history of heart disease may be harmed by hormone therapy.”