Does hormone therapy increase the risk of stroke?

This review examined the relationship between androgen deprivation therapy (ADT) and the risk of stroke. Researchers reported a moderate increase in the risk of stroke among prostate cancer patients undergoing ADT.

Androgen deprivation therapy (ADT) is a type of hormone therapy commonly used to treat prostate cancer. ADT targets the production of androgens (male sex hormones such as testosterone) and reduces their effect on cancer cell growth. ADT can involve the surgical removal of the testicles (also called orchiectomy) or drug treatment. Drug treatments either lower the production of testosterone in the body (GnRH agonists) or block the action of androgens (antiandrogens).

Previous studies have suggested that there is an increased risk of stroke among patients receiving ADT. However, evidence for this is mixed, with some studies reporting no effect, or even a protective effect, of ADT on the risk of stroke.

This review investigated the possible link between ADT and stroke. 6 separate trials were included in the analysis, involving a combined total of 160,485 men with prostate cancer. 74,538 of these men were undergoing ADT and 85,947 men were undergoing alternative treatment (such as prostate surgery or radiation therapy). Health outcomes were compared over an average of 4 years.

7.4% of ADT-treated men experienced a stroke compared to 5.7% of men receiving alternative treatment. While the risk of stroke was 12% higher for ADT than for alternative treatment., this was not statistically significant.

Different ADT methods were associated with different degrees of risk. Surgical removal of the testicles was associated with a 37% increased risk of stroke. GnRH agonists were associated with a 20% increased risk of stroke. GnRH agonists combined with antiandrogens were associated with a 23% increased risk of stroke. Treatment with antiandrogens alone did not affect stroke risk.

The authors concluded that ADT can increase the risk of stroke in prostate cancer patients. Men should be informed about possible risk factors before treatment with ADT.

Discuss with your doctor any possible stroke risk factors.