Hormones Increase Risk in Some Prostate Cancer Patients

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Use of hormone therapy may increase the risk of death in prostate cancer patients who have heart disease, according to a recently published study in the Journal of the American Medical Association. The study found that men who had localized or locally advanced prostate cancer and a history of coronary artery disease had a nearly twofold risk of death when compared with similar cancer patients who had no underlying cardiac condition or only one risk factor for coronary artery disease.

Prostate cancer is second only to skin cancer as the most common cancer in American men. According to the American Cancer Society, about 192,280 new cases of prostate cancer will be diagnosed in 2009, and 27,360 men will die of the disease. Currently there are more than 2 million men in the United States who have been diagnosed with prostate cancer.

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In the current study, Dr. Akash Nanda, a radiation oncology resident with the Harvard Radiation Oncology Program at Brigham and Women’s Hospital/Dana-Farber Cancer Institute in Boston and his colleagues evaluated 5,077 men (median age, 69.5 years) with localized or locally advanced prostate cancer who had been treated with radiation therapy alone (70% of participants) or radiation plus hormone therapy (30%) between 1997 and 2006 and who were followed up until July 2008.

Nanda’s team found that hormone therapy was associated with a significantly increased risk of all-cause mortality in men who had coronary artery disease compared with those who had no coronary artery disease or only one risk factor (26.3% vs 11.2%).

Although it’s known that hormone therapy can increase survival in men who have aggressive prostate cancer, the results of this study can guide clinicians when they determine which patients should be considered for this treatment. In a Medscape Medical News article, Dr. Nanda notes that “The study does not address whether or not treatment for coronary artery disease potentially changes the risk for these patients.” While the results of this study highlight the need for physicians to more carefully consider hormone treatment in men who have prostate cancer, further investigations are still needed.

SOURCES:
American Cancer Society
Medscape Medical News 8/25/09
Nanda A et al. JAMA 2009; 302:866-873
US News & World Report, 8/25/09

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