Hormone Therapy for Early Prostate Cancer Not Always Best

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Until now, however, experts have not known which other conditions were responsible for the jump in risk.

"There have already been a fair number of studies looking at this question, which have tended to suggest a problem with hormone therapy causing cardiac death but not consistently," Ennis said. "The thing this study has been able to do that others have not is to break people down by their risk for having cardiac disease."

Nanda and his colleagues looked at more than 5,000 men, average age about 70, with localized or locally advanced prostate cancer who were treated with radiation therapy alone or radiation therapy plus hormone therapy. Participants were followed for close to five years.

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Hormone therapy was not linked with a higher risk of death from any cause in men who had no underlying cardiac conditions or only one risk factor for coronary artery disease.

But men who had congestive heart failure or who had suffered heart attacks as a result of coronary artery disease had almost double the risk of death, the researchers found.

Overall, however, only 5 percent of the initial 5,000 men studied experienced an increased death rate as a result of hormone therapy.

"Men with favorable risk [less aggressive] prostate cancer only receive hormone therapy to shrink their gland and make them eligible for brachytherapy [radioactive "seeds" are planted inside the malignant tissue] and, in that setting, if the patient has a history of heart attack or heart failure, we would recommend that they consider alternative treatment strategies such as external beam radiation alone or active surveillance [doctors follow the cancer without actually treating it at that time]," Nanda said.

"But for men who have more aggressive cancer, several clinical trials have shown that adding hormone therapy to radiation actually leads to an increase in survival and so, for this cohort of men, our results would suggest that if they do have preexisting heart disease that either hormone therapy not be used or that their underlying heart disease be initially addressed by their primary care physician and/or a cardiologist," Nanda added. "The risks need to be balanced with the benefits. For more advanced disease, the primary treatment is a combination of hormone therapy and radiation. So, for them, it becomes a little more tricky."

More information

The U.S. National Cancer Institute has more on prostate cancer.

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