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Hormone Therapy Increases Risk of Death in Patients With Prostate Cancer, Heart Conditions CHICAGO -- August 25, 2009 -- Men with coronary artery disease-induced congestive heart failure or myocardial infarction (MI) who receive hormone therapy (HT) before or along with radiation therapy for treatment of prostate cancer have an associated increased risk of death, according to a study published in the August 26 issue of JAMA. Previous research has suggested that “hormonal therapy when added to radiation therapy (RT) for treating unfavourable-risk prostate cancer leads to an increase in survival except possibly in men with moderate to severe comorbidity. However, it is unknown which comorbid conditions eliminate this survival benefit,” the authors wrote. Akash Nanda, MD, Brigham & Women’s Hospital, and Dana-Farber Cancer Institute, Boston, Massachusetts, and colleagues assessed whether neoadjuvant HT 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 MI. The study included 5,077 men (median age, 69.5 years) with localised or locally advanced prostate cancer who were treated with or without a median of 4 months of neoadjuvant HT followed by RT between 1997 and 2006 and were followed up until July 2008. During the study period, 419 men died. Of those, 200 had no underlying comorbidity, 176 had 1 coronary artery disease risk factor, and 43 had a history of known coronary artery disease resulting in congestive heart failure or MI. Analyses of the data indicated that “when considering comorbidity groups separately, neoadjuvant HT 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 5.0 years and 4.4 years, respectively,” the authors wrote. However, for men with coronary artery disease-induced congestive heart failure or MI, after a median follow-up of 5.1 years, neoadjuvant HT use was associated with nearly twice the risk of all-cause mortality (26.3% vs 11.2%). “It is also important to note that the population of men in whom the use of neoadjuvant HT may be detrimental was limited to 5% (256 of 5,077) 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 randomised trials comparing HT plus external beam radiation therapy to external beam radiation therapy alone.” “The clinical significance of this finding is that for men with favourable-risk prostate cancer and a history of congestive heart failure or myocardial infarction who require neoadjuvant HT solely to eliminate pubic arch interference, alternative strategies such as active surveillance or treatment with external beam radiation therapy or prostatectomy should be considered,” the authors wrote. “However, for men with unfavourable-risk prostate cancer who require HT in addition to radiation therapy to take advantage of its survival benefit, appropriate medical evaluation prior to initiation should facilitate clinicians in balancing the relative risks against the benefits of HT use.” SOURCE: JAMA E-mail this page to a friend or colleague! To print, use this version