Hormonal therapy combined with radiation therapy for treating prostate cancer can make existing cardio problems worse, according to a study in the Journal of the American Medical Association.
Previous research had indicated that hormonal therapy, when combined with radiation therapy, usually leads to an increase in survival, except possibly in men with co-existing illnesses. It was unknown until now which pre-existing conditions eliminate this survival benefit.
The study included more than 5,000 men with localized or locally advanced prostate cancer who were treated with or without hormone therapy followed by radiation therapy between 1997 and 2006.
During the study period, 419 men died. Of those, 200 had no pre-existing condition, 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. For men with coronary artery disease-induced congestive heart failure or heart attack, hormone therapy use was associated with nearly twice the risk of mortality.
"The clinical significance of this finding is that for men with favorable-risk prostate cancer and a history of congestive heart failure or myocardial infarction who require HT [hormone therapy] solely to eliminate pubic arch interference, alternative strategies such as active surveillance or treatment with external beam radiation therapy or prostatectomy should be considered. However, for men with unfavorable-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," the researchers concluded.
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Source: Journal of the American Medical Association