Hormone therapy ups death risk for prostate cancer patients with heart disease

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Washington, Aug 26 (ANI): Prostate cancer patients, who also suffer from heart conditions, have increased death risk if they undergo hormone therapy, revealed a study led by an Indian-origin scientist.

Dr. Akash Nanda, from Boston, has found that when men with coronary artery disease-induced congestive heart failure or heart attack receive hormone therapy before or along with radiation therapy for treatment of prostate cancer, they have an associated increased risk of death.

His study report says that patients with localized prostate cancer have several options available for treatment, including the use of brachytherapy (treatment in which radioactive seeds are implanted in the prostate), both as monotherapy and in conjunction with external beam radiation therapy.

Neoadjuvant (treatment that is given before or with the primary treatment) hormonal therapy (HT) is used as a means for prostate gland cytoreduction (decrease in number of cells, as in a tumor) in order to eliminate pubic arch (an arch formed by the pubic bones) interference and improve the ability to perform brachytherapy.

Previous research has suggested that "hormonal therapy, 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 write.

Dr. Nanda his colleagues assessed whether neoadjuvant HT use in men with prostate cancer treated with brachytherapy affects the risk of all-cause death of men with known coronary artery disease-induced conditions, including congestive heart failure and heart attack.

The researchers conducted the study on 5,077 men (median [midpoint] age, 69.5 years) with localized or locally advanced prostate cancer who were treated with or without a median of 4 months of neoadjuvant HT followed by RT between 1997 and 2006 and were followed up until July 2008.

They found that during the study period, 419 men died, out of which, 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 researchers said that the analyses of 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."

But, for men with coronary artery disease-induced congestive heart failure or heart attack, after a median follow-up of 5.1 years, neoadjuvant HT use was associated with nearly twice the risk of all-cause mortality.

"The clinical significance of this finding 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.

"However, for men with unfavourable-risk prostate cancer who require HT in addition to radiation therapy to take advantage of its survival benefit, appropriate medical evaluation prior to initiation should facilitate clinicians in balancing the relative risks against the benefits of HT use," said the researchers

The study has been published in the latest issue of JAMA. (ANI)

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