Prostate cancer patients with heart disease should skip hormone therapy, study says

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Hormone therapy to reduce the levels of testosterone and dihydrotestosterone in the body is often an important part of treatment for prostate cancer. Deprived of those hormones, the cancer may shrink or at least grow more slowly, making it easier to attack with radiation.

But a new study finds that for some men, the hormone treatment does more harm than good.

For men with certain kinds of heart disease, getting hormone therapy in addition to traditional brachytherapy nearly doubled the risk of death, according to a study being published in Wednesday’s edition of the Journal of the American Medical Assn.

Among 256 men in the study who had congestive heart failure or a heart attack as a result of coronary artery disease, 95 got hormone therapy and 161 did not. The rate of all-cause mortality was 26.3% for patients treated with hormones, compared with 11.2% for patients who skipped it. When the numbers were adjusted to account for factors like age, duration of treatment and Gleason score, the risk of death was 96% higher in the hormone group.

Patients without heart disease, or who had only one risk factor for coronary artery disease, did not appear to be put at heightened risk by taking hormones, the study found. Nor were patients with other kinds of risk factors, such as diabetes, hypercholesterolemia or high blood pressure.

The researchers noted that of the 5,077 prostate cancer patients enrolled in the study, only 5% had congestive heart failure or a heart attack. That small number may explain why this effect has not been detected before. In light of this data, the study’s authors recommend that men with heart disease consider alternatives to hormone therapy, such as external beam radiation or prostatectomy.

-- Karen Kaplan