Could Androgen Deprivation Therapy Increase Risk of Heart Attack?
In men with unfavorable-risk prostate cancer, especially in those with a history of prior heart attack, treatment with both radiation therapy (RT) and androgen deprivation therapy (ADT) resulted in significantly greater risk of fatal heart attack, compared to those treated with RT alone, according to a recent study.1
While combination of ADT and RT is considered a standard of care due to its ability to prolong survival in prostate cancer patients, a 2008 warning from the FDA suggested the combo might also be responsible for increased risk of non-fata cardiovascular events.
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To explore the long-term risk associated with combination treatement with ADT and RT, researchers followed a group of 206 men with unfavorable risk prostate cancer randomized to receive either RT alone or RT and 6 months of ADT. Participants were also categorized based on prior comorbidity.
After a mean 16 years of follow-up, researchers found that treatment with ADT and RT was associated with higher rates of fatal heart attack among men who had had a prior heart attack. In patients without previous comorbidity, the combination treatment was associated with prolonged survival.
"These findings give us reason to rethink how we manage prostate cancer in men with known heart disease," researchers concluded. "Specifically, we should be cautious in prescribing ADT in all men who have had a prior heart attack. Men with significant heart disease that is not amenable to medical or surgical correction may be best served with RT alone."2
—Michael Potts
Reference:
1. D’Amico AV, Chen M, Renshaw A, et al. Long-term follow-up of a randomized trial of radiation with or without androgen deprivation therapy for localized prostate cancer. JAMA. 2015;314(12):1291-1293.
2. Bringham And Women’s Hospital. Androgen deprivation therapy associated with increased risk for fatal heart attack [press release]. September 22, 2015. http://www.eurekalert.org/pub_releases/2015-09/bawh-adt092115.php