Cardiovascular Issues and Hormonal Therapy.

In November, 2011, I had my six-month appointment with my oncologist at Moffitt Cancer Center, University of South Florida, Tampa.  My prostate cancer is in remission and I  currently receive no hormonal (androgen deprivation, ADT) therapy with Lupron until my PSA begins to rise. When my micro metastases are not under hormonal control, my PSA doubles in three months hence doctors label my cancer as “aggressive”. But for now, my PSA remains ‘undetectable’ for which I am grateful to God and I am on intermittent therapy to minimize the potential side effects of ADT. I expressed to my oncologist that it was my most sincere prayer that I not die of prostate cancer to which he confidently responded that it was much more likely that I would die of cardiovascular causes instead of cancerous ones. He also specified that I was “too good for participation in clinical trials of new therapies”. I do try to maintain good cardiac health with diet, medication and exercise under the care of a cardiologist.

While I was thankful for the opinions expressed by my oncologist, I recently read several on-line articles dealing with potential cardiovascular and metabolic syndrome side effects related with hormonal therapy. The December 20th, 2011 issue of the Prostate Cancer Foundation Newsletter contained an article which stated that “hormone drugs might not raise heart-related deaths in prostate patients” but for those with a history of heart disease, stroke may pose a higher risk. To further substantiate this conclusion, the December 13th, 2011 issue of the National Cancer Institute (NCI) Bulletin  contained an article entitled “Prostate Cancer Trials Show No Link Between Androgen-Deprivation Therapy and Cardiac Deaths.” A new analysis of eight clinical trial results showed no evidence that ADT increased the risk of cardiovascular deaths in the case of patients with non-metastatic, high-risk prostate cancer. The original article had been published in the Journal of the American Medical Association (JAMA) by researchers from the Dana-Farber Cancer Institute who cited an additional benefit that men who had been treated with ADT had a lower risk of dying from prostate cancer and other causes than men who did not. Their conclusions however could not be extrapolated to men with a history of cardiovascular disease who could potentially be harmed by ADT.

Hormonal prostate cancer therapy has recently been associated with blood clots. An article by Amy Norton published December 1, 2011 by Reuters Health, stated that hormonal therapy for  prostate cancer “may raise the risk of potentially-dangerous blood clots” according to a U.S. study led by Dr. Behfar Ehdaie of the Memorial-Sloan Kettering Cancer Center in New York and published in the journal Cancer. Dr. Ehdaie cautions that for men weighing their options for prostate cancer treatment, the risk of blood clots and other side effects needs to be balanced against potential  benefits. It is not proven that hormonal therapy itself is the direct cause of the blood clots but men on ADT had a 56% greater chance of developing a blood clot. The clot risk also increased the longer a man was on the treatment. It is possible that hormone therapy’s negative effects on metabolism might increase a man’s fat mass. Men are urged to discuss the risks and benefits of hormonal therapy and other treatments with their physician.

 

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