Hormone therapy: a risk factor for stroke and heart attacks in patients with prostate cancer

This study examined the link between androgen-deprivation therapy (ADT) and risk for developing heart attack or stroke in patients with prostate cancer.

Prostate cancer cells often require androgen hormones (male sex hormones such as testosterone) to grow. ADT is intended to reduce the production of androgens or inhibit their effect on cancer cell growth. ADT can involve either drug treatment with medical endocrine hormonal therapy or surgical removal of the testicles (orchiectomy). Drug treatment involves either the administration of gonadotropin-releasing hormone agonists (GnRH agonists; drugs that lower the production of testosterone in the body) or antiandrogens (block the action of androgens). The use of ADT has been indicated for the treatment of symptomatic, locally advanced (cancer has spread through the wall of the prostate) and metastatic prostate cancer (cancer that has spread to other organs).

Previous scientific studies suggest that there is an increased risk for heart attack and stroke in patients receiving ADT. However, this suggestion remains controversial. This study investigates if the increased risk exists.

31,571 men with a primary diagnosis of prostate cancer and an average age of 71 were included. Patients were divided into three treatment groups: medical endocrine therapy (29%), orchiectomy (7%) and those receiving neither (64%). Patients were followed for an average of 3.3 years after diagnosis.

Compared to those not receiving ADT, those receiving medical endocrine therapy had a 31% increased risk of heart attack and a 19% increased risk of stroke.  This result held true even after statistically adjusting for patients’ age, cancer stage, study year, and all other co-existing medical conditions. An increased risk for heart attack and stroke was not seen in patients who underwent orchiectomy.

The authors concluded that medical endocrine therapy increased the risk for heart attack and stroke in patients with prostate cancer.

As patients were not divided based on the specific endocrine therapy they received (GnRH agonists or antiandrogens) it is not clear whether one of these treatments is a bigger risk.

If considering ADT therapy, discuss the benefits and drawbacks of this treatment regimen with your doctor. If undertaking ADT, discuss the possibility of monitoring cardiovascular function with your doctor.