Hormone Therapy for Prostate Cancer May Increase Risk of Mortality From Cardiovascular Disease

Men--and especially older men--with prostate cancer have an increased risk of death from heart disease with hormone therapy, according to the results of a study conducted in Lithuania and published in The Aging Male.¹

“Hormone therapy is often used for patients with prostate cancer, but more research is now needed to gain a better understanding of the overall risks and benefits of this treatment,” said study author Justinas Jonusas, MD, of the National Cancer Institute in Lithuania, in the press release.¹

The hormone therapy used for prostate cancer treatment is androgen deprivation therapy (ADT), which can help to decrease levels of testosterone in the body which can cause prostate cancer by fueling excessive cell growth.^1,2 According the study authors, past research has suggested that there are ill-effects of hormone therapy on cardiovascular health, but not enough studies have been done to link hormone therapy with prostate cancer and cardiovascular disease.¹

"There are some cases where it's clear men need hormonal therapy,"said William Dahut, MD, a prostate cancer researcher and the chief scientific officer for the American Cancer Society, in the press release.² "But oftentimes it's used for patients that are newly diagnosed, that are receiving radiation, or with men that have a rising PSA [prostate specific antigen] without cancer that we can see, something called biochemical recurrence."²

During the study, investigators used data from the Lithuanian cancer registry to identify male patients aged 40 to 79 years who were diagnosed with prostate cancer between 2012 to 2016.2 To determine the risk of death by heart disease, they compared 3797 patients who had received hormone-lowering drugs and 9546 patients who had not. Approximately 5 years later, the investigators followed up with the patients.¹

Based on the results, the investigators found there was a 2-fold increase in risk of mortality by cardiovascular disease in the group who received hormone therapy. They also noticed the risk of death increased after the second year of cancer diagnosis, along with a 5-fold increased risk for patients older than age 70 years.¹

For men treated with hormone therapy, the risk of death from subtypes of cardiovascular disease increased, showing a 42% increased risk of death by stroke and a 70% increased risk of death from coronary heart disease.¹

“Prostate cancer is typically diagnosed in older men, over 65 years or older--and many of them will have already been diagnosed with cardiovascular disease. It is therefore concerning that we found such a tremendous increase in the risk of cardiovascular disease-related death in elderly males receiving hormone-lowering drugs,” Jonusas said in a press release.¹

Furthermore, Jonusas noted that screening for pre-existing cardiovascular disease and risk factors can help minimize the mortality risk from heart conditions among older men in particular.¹

However, other cancer treatments may also increase cardiovascular risk as well, explained Katelyn Atkins, MD, PhD, a specialist in radiation oncology at Cedars-Sinai Cancer Institute in Los Angeles, in the press release.² However, when it comes to cancer, providers may treat patients despite these increased risks.²

To address this issue, Dahut explained patients should be treated with ADT and other cancer treatments on a case by case basis to determine risk, noting specifically that further research was needed to aid in this process.

“If we can do research to differentiate those populations, it will make the discussions much easier for patients and their physicians," Dahut said.²

References

1. Hormone therapy for prostate cancer increases the risk of dying from cardiovascular disease. Taylor & Francis Group; July 27, 2022. Accessed July 27, 2022.https://www.eurekalert.org/news-releases/959617
2. Murez C. Prostate Cancer Treatment May Raise Heart Risks. US News. July 27, 2022. Accessed July 27, 2022. https://www.usnews.com/news/health-news/articles/2022-07-27/prostate-cancer-treatment-may-raise-heart-risks