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Senior Citizen Health & Medicine
Seniors May Increase Risk of Heart Disease from
Prostate Cancer Treatment
Longer they received ADT, the sooner they were likely
to die
Feb. 26, 2007 - One of the most common treatments
for prostate cancer - androgen deprivation therapy - may increase the
risk of death from heart disease in senior citizens over age 65,
according to a new study by researchers at Dana-Farber Cancer Institute,
Brigham and Women's Hospital and other institutions.
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Although the findings need to be confirmed in
clinical trials, the study authors state that oncologists should weigh
the benefits of androgen deprivation therapy, or ADT, against the risk
of heart problems in older prostate cancer patients. The study results
were based on data from CaPSURE, a national registry of men with
prostate cancer.
The researchers presented their study at the
Prostate Cancer Symposium in Orlando, Fla., on Saturday. The symposium
is sponsored by the American Society of Clinical Oncology, the American
Society for Therapeutic Radiology and Oncology and the Society of
Urologic Oncology.
The goal of ADT is to block the level of
circulating androgens (male hormones), which can fuel the growth of
prostate cancers. "Androgen deprivation therapy is associated with
elevated body mass index, increased body fat deposits and diabetes, all
of which raise the risk of death from heart diseased," explains the
study's lead author, Henry Tsai, MD, a resident physician at
Dana-Farber, Brigham and Women's and the Harvard Radiation Oncology
Program.
"Although our findings demonstrated that older men
receiving this treatment may be at increased risk, even after taking
into account other cardiovascular risk factors, a prospective clinical
trial would be needed to confirm a cause-and-effect relationship."
Drawing on the CaPSURE database, Tsai and his
colleagues compared the number of cardiac-related deaths among 735 men
with localized prostate cancer who received ADT and among 2,901 men with
the disease whose treatment did not include ADT.
After factoring in other known risks for
cardiovascular disease (such as diabetes, hypertension, body mass index
and smoking), researchers found that the longer patients received ADT,
the sooner they were likely to die from heart disease. When the
researchers analyzed the data by patients' age, the link between ADT use
and death from heart disease was significant in patients over age 65,
but not in those under 65. After five years, 3 percent of older men who
received androgen deprivation therapy died of cardiac causes, compared
with only 0.9 percent of men who did not receive the therapy.
"These findings should help oncologists determine
which older patients are the best candidates for ADT," Tsai remarks. "If
a patient is at high risk of cardiovascular disease, it would be
advisable for an oncologist to discuss the pros and cons of ADT
treatment with him before proceeding on a course of treatment."
Editor's Notes:
Co-authors of the study include Anthony D'Amico,
MD, PhD, of Dana-Farber and Brigham and Women's, Ming-Hui Chen, PhD, of
the University of Connecticut, and Natalia Sadetsky, MD, MPH, and Peter
R. Carroll, MD, both of the University of California, San Francisco.
The CaPSURE database is a research collaboration
between TAP Pharmaceutical Products, Inc., and the University
California, San Francisco, Department of Urology. The study was funded
in part by the CaPSURE Scholars Program in Prostate Cancer Outcomes
Research.
Dana-Farber Cancer Institute (www.danafarber.org)
is a principal teaching affiliate of the Harvard Medical School and is
among the leading cancer research and care centers in the United States.
It is a founding member of the Dana-Farber/Harvard Cancer Center (DF/HCC),
designated a comprehensive cancer center by the National Cancer
Institute.
Brigham and Women's Hospital is a 747-bed
nonprofit teaching affiliate of Harvard Medical School and a founding
member of Partners HealthCare System, an integrated health care delivery
network. BWH is committed to excellence in patient care with expertise
in virtually every specialty of medicine and surgery. The BWH medical
preeminence dates back to 1832 and today that rich history in clinical
care is coupled with its national leadership in quality improvement and
patient safety initiatives, dedication to educating and training health
care professionals, and strength in biomedical research. With $370M in
funding and more than 500 research scientists, BWH is an acclaimed
leader in clinical, basic and epidemiological investigation - including
the landmark Nurses Health Study, Physicians Health Studies, and the
Women's Health Initiative. For more information about BWH, please visit:
www.brighamandwomens.org.
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