Dueling Views on the Risks of Androgen Deprivation in Prostate Cancer

In early December a study reported in the Journal of the American Medical Association showed that androgen deprivation therapy – a treatment aimed at inhibiting the production of male sex hormones – for the treatment of prostate cancer was not linked to an increased risk of cardiovascular events, including mortality.   

This report covered a meta-analysis of randomized clinical trials of androgen-deprivation therapy (ADT) in men with non-metastatic but unfavorable prostate cancer.  Eight relevant studies were found, which included 4,141 patients. The overall incidence of cardiovascular deaths was 11% for men treated with ADT, compared to an incidence of 11.2% in the control groups.  The percentages were similar in both groups of patients whether the ADT therapy was short (6 months or less) or longer (3 years or more).  The incidence of prostate-cancer-related mortality was 13.5%, compared with 22.1% for the control groups.  This reflects the beneficial effects of ADT on the cancer; it also resulted in lower all-cause mortality for the ADT treated men.

An opposing view was reported online in the journal Heart.  The authors, from Sheffield, UK, maintain that there is mounting evidence that ADT raises the risk of heart disease and stroke, and that ADT is being used in earlier stages of prostate cancer than originally recommended – largely due to the use of prostate specific antigen (PSA) testing.  They quote an earlier joint statement from the American Heart Association, the American Cancer Society, and the American Urological Association in support of this viewpoint.  And they cite one study that estimates that for every 1,000 men receiving ADT for 5 years, there will be an additional 360 extra cases of diabetes, 315 cases of heart disease, 42 more strokes, and 28 additional heart attacks.

It’s difficult to reconcile these opposing viewpoints.  There is a plethora of clinical trials of ADT, and it’s possible that differences in the selection of studies for review may be responsible for the different outcomes of the two conflicting reports.  What’s a potential patient to conclude/  Until a more definitive answer is available, he should probably assume that ADT, although a valuable treatment of prostate cancer, carries a possible risk of cardiovascular side effects, and therefore he and his physician should be aware of symptoms and signs suggesting such a problem.  If such a watch is instituted, there’s no reason not to undergo AFT treatment with the expectation of a good outcome.