Hormone therapy before radiation therapy: reduced survival in low-risk prostate cancer?

This study investigated the effects of hormone therapy given before brachytherapy (a form of radiation therapy) on the survival of prostate cancer patients with at least one risk factor for coronary artery disease compared to those with no risk factors. 

Quite often, hormone therapy such as anti-androgen therapy is administered to reduce tumour size prior to other treatments such as radiotherapy or surgery. This is referred to as ‘neoadjuvant hormone therapy’. It has been seen previously that administering hormone therapy before the main therapy is associated with lower survival in prostate cancer patients with a history heart attack or heart failure. No studies to date have assessed whether neoadjuvant hormone therapy affects mortality in men with no or at least a single risk factor for coronary artery disease (occurs when a waxy substance builds up inside the arteries that supply the heart).

This study aimed to evaluate the relationship between neoadjuvant hormone therapy, coronary artery disease risk factors and death from any cause in prostate cancer.

This study involved 11,166 prostate cancer patients divided into three groups based on the status of their prostate cancer: low-risk (5,411), intermediate-risk (4,365) and high-risk (1,360). Men did or did not receive neoadjuvant hormone therapy for 4 months. All men subsequently underwent radiotherapy (brachytherapy with or without external-beam radiation therapy, another form of radiotherapy). The average follow-up was 4 years. Coronary artery disease risk factors assessed were high blood pressure, high cholesterol or diabetes.

In low-risk prostate cancer patients, neoadjuvant hormone therapy use was shown to be associated with 27% increased risk of death from any cause, but not in intermediate-risk or high-risk patients.

Among those who underwent neoadjuvant hormone therapy, those with at least a single coronary artery disease risk factor had a significant 36% increased risk of death from any cause, compared to those who had no coronary artery disease factors who had a 19% increased risk. 

The authors concluded that neoadjuvant hormone therapy is associated with an increased risk of death from any cause in low-risk prostate cancer, particularly in those with at least one risk factor for coronary artery disease.

Assessment of risk factors was based on patient self-reporting and so may have not been reliable. 

If you are considering hormone therapy prior to radiation therapy, talk to your doctor about benefits and risks.