Advisory: ADT for prostate cancer may increase CVD risk, mortality

Physicians treating for cancer should weigh risks and benefits of treatment, according to advisory.

The use of androgen deprivation therapy to treat prostate cancer may increase cardiovascular risk factors and the risk for myocardial infarction and cardiac death, a scientific advisory from several major medical associations has concluded.

The advisory, produced by a writing group of experts from the American Heart Association, ACS, American Urological Association and the American Society for Therapeutic Radiology and Oncology, is an evaluation of published research about the relationship between ADT and CVD events and risk factors in patients with prostate cancer. It was published in Circulation: Journal of the American Heart Association.

To date, several studies have found an association between ADT and increased CVD risk. Among them are two published reports that used information from the SEER database. In the first, men assigned ADT for prostate cancer had increased risk for coronary heart disease (HR=1.16), MI (HR=1.11) and sudden cardiac death or life-threatening arrhythmia (HR=1.16). The second study found that these same men also had a 20% increased risk for serious CVD morbidity at five-years’ follow-up.

Despite this, not all published data on the topic support the relationship between ADT and CVD risk. According to the advisory statement, four studies analyzed by the group reported no association between ADT and CVD mortality. Therefore, questions remain as to whether there is a cause-and-effect relationship between the two, and studies are still being conducted to examine this relationship.

Advisory recommendations

Based on available data, the experts from these groups were able to issue certain recommendations. The group said the recommendations are “strictly informative” and “should thus not be construed as dictating clinical practice or superseding the clinical judgment of physicians.”

First, the group concluded that because of these increased CVD risks, all patients assigned ADT should be referred to their primary care physician for routine follow-up assessment of blood pressure, lipid profile and glucose levels.

“Given that some of the effects of ADT occur within the first three months of treatment, it may be reasonable for an initial follow-up evaluation to occur within three to six months after initiation of therapy,” they wrote. Further intervals of follow-up may be decided by the referring physician or the PCP.

Information should be provided to the PCP about the potential adverse effects of ADT.

Next, the group said a referral to an internist, cardiologist or endocrinologist before the initiation of ADT is likely unnecessary. Instead, the decision of whether to initiate ADT should be made by the physician treating for prostate cancer, after careful consideration of the risks and benefits of treatment.

Finally, the group recommended that all future studies prospectively analyze heart risks related to ADT whenever possible.

Levine GN. Circulation. 2010;doi:10.1161/CirculationAHA.109.192695.