Experts Issue Warning on Prostate Hormone Therapy

Men with prostate cancer and the physicians who treat them are being warned that the androgen-deprivation therapy (ADT) commonly used against the malignancy might increase the risk of heart attack and cardiac death.

"There is a substantial amount of data demonstrating that ADT adversely affects traditional cardiovascular risk factors, including serum lipoproteins, insulin sensitivity, and obesity," according to an advisory published online in Circulation.

The warning is guarded, saying that risks have not been found in all studies. "But we think that physicians treating patients with localized and metastatic prostate cancers as well as patients ought to realize that there are significant risks associated with the use of hormone therapy," says Otis Brawley, MD, chief medical officer of the American Cancer Society.

ADT reduces or eliminates the male hormones that can promote growth of prostate cancer. About one third of all men with prostate cancer are given ADT, Brawley notes. "Many people underestimate the harm of hormonal therapy and overestimate the potential benefits of hormonal therapy," he says.

"These drugs do have usefulness," Brawley says. But there has been debate about whether ADT should be used in some cases, such as when levels of prostate-specific antigen (PSA), a cancer-associated protein, begin to go up but there are no other signs and symptoms of cancer progression, he says.

"A man has had radical prostatectomy [cancer surgery] and PSA starts rising again," Brawley says. "There has been a debate in the medical profession: Should we start hormonal therapy or just watch it go up and act only if we see the cancer spreading?"

More research is needed to determine the proper course of action in these and other cases where the course of the disease is not clear, the new advisory said.

Meanwhile, "the American Cancer Society is advising that physicians be aware that all hormone therapies for prostate cancer can have an increased risk of cardiovascular disease and diabetes and death," Brawley says. "They can be useful in treatment but should be used with caution."

— Source: Brigham and Women's Hospital