Androgen Deprivation Therapy for Localized Prostate Cancer

Androgen Deprivation Therapy for Localized Prostate Cancer Associated with Cardiovascular-related Death

According to an article recently published in the Journal of the National Cancer Institute, use of androgen deprivation therapy (ADT) is associated with an increased risk of death from cardiovascular causes in patients treated for localized prostate cancer.

The prostate is a gland of the male reproductive system. It produces some of the fluid that transports sperm during ejaculation. After skin cancer prostate cancer is the most common form of cancer diagnosed in men. The outlook for men diagnosed with prostate cancer is good: overall survival rates for all stages of prostate cancer have improved dramatically over the past 20 years.

Current treatment options for prostate cancer include watchful waiting, surgery, chemotherapy, radiation, or ADT (also referred to as hormonal therapy). ADT is designed to block testosterone from stimulating the growth of hormone-dependent types of prostate cancer. However, because long-term survival for this stage of disease remains high with several treatment modalities, ADT’s individual role in long-term survival is not yet fully understood. In addition, the side effects associated with ADT must be weighed against its benefits; side effects are a particular consideration for this group of patients because they often achieve long-term survival and as a result may have to cope with side effects of treatment for an extended period.

Researchers from the United States recently conducted a clinical study evaluating data including patients with prostate cancer treated with ADT. This study included data from 3,262 patients with early prostate cancer who were treated with surgery (radical prostatectomy) and 1,630 patients treated with radiation therapy or cryotherapy. Overall, 1,105 patients also received ADT. Follow-up was approximately four years.

  • The median duration of ADT use was four months.
  • The use of ADT was associated with a greater than twofold increased risk of death from cardiovascular causes.
  • Among patients 65 years or older who were treated with surgery, cardiovascular death occurred in 5.5% of patients treated with ADT and 2% of those who didn’t receive treatment with ADT.
  • Among patients 65 year or older and treated with radiation therapy, the rates of death from cardiovascular causes were also increased among patients treated with ADT compared with those who did not receive treatment with ADT.

The researchers concluded: “The use of ADT appears to be associated with an increased risk of death from cardiovascular causes in patients undergoing radical prostatectomy for localized prostate cancer.” Patients with early prostate cancer may wish to speak with their physician regarding their individual risks and benefits of all treatment options for their disease.

Reference: Tsai H, D’Amico A, Sadetsky N, et al. Androgen deprivation therapy for localized prostate cancer and the risk of cardiovascular mortality. Journal of the National Cancer Institute [early online publication]. October 9, 2007. DOI: 10.1093/jnci/djm168.

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