Hormone therapy in men with PCa, heart conditions raises death risk

Men with coronary artery disease-induced congestive heart failure or heart attack who receive hormone therapy before or with radiation therapy for treatment of prostate cancer have an associated increased risk of death, according to researchers at Brigham & Women's Hospital-Dana Farber Cancer Institute, Boston.

The study, published in JAMA (2009; 302:886-73), assessed whether neoadjuvant hormone therapy use in men with prostate cancer treated with brachytherapy affects the risk of all-cause death of men with known coronary artery disease-induced conditions, including congestive heart failure and heart attack. The study included 5,077 men (median age, 69.5 years) with localized or locally advanced prostate cancer who were treated with or without a median of 4 months of neoadjuvant hormone therapy followed by radiation therapy between 1997 and 2006. They were followed until July 2008.

Of 419 men who died during the study period, 200 had no underlying comorbidity, 176 had one coronary artery disease risk factor, and 43 had a history of known coronary artery disease resulting in congestive heart failure or heart attack.

Analyses of the data indicated that neoadjuvant hormone therapy use was not associated with an increased risk of all-cause mortality in men with no comorbidity (9.6% vs. 6.7%) or a single coronary artery disease risk factor (10.7% vs. 7.0%) after median follow-ups of 5 years and 4.4 years, respectively.

However, in men with coronary artery disease-induced congestive heart failure or heart attack, after a median follow-up of 5.1 years, neoadjuvant hormone therapy use was associated with nearly twice the risk of all-cause mortality (26.3% vs. 11.2%), reported the authors, led by Akash Nanda, MD, PhD, and senior author Anthony D'Amico, MD, PhD.

"It is also important to note that the population of men in whom the use of neoadjuvant hormone therapy may be detrimental was limited to 5% in this community-based study cohort," the authors wrote. "This latter point may explain why there has been a survival benefit observed in the major randomized trials comparing hormone therapy plus external beam radiation therapy to external beam radiation therapy alone."