This article is more than 5 years old. Information may no longer be current.
Endocrine treatments may increase heart disease risk in advanced, metastatic prostate cancer
ECCO 15 – ESMO 34 Multidisciplinary Congress
Orchiectomy and other endocrine therapies, including gonadotropin-releasing hormone agonists and antiandrogen monotherapy, were associated with an increased risk for heart disease among men with locally advanced and metastatic prostate cancer, according to data presented at the ECCO 15 – ESMO 34 Multidisciplinary Congress in Berlin. Antiandrogen therapy was associated with the lowest increase in the risk for ischemic heart disease, myocardial infarction and heart failure.
“This is a large observational study, so we cannot come up with direct causal explanations, but it really shows that it’s important to take heart disease into account before starting patients with prostate cancer on endocrine treatment — especially since endocrine treatment these days is not only used for patients with metastatic prostate cancer but also for more and more patients with less severe diseases,” Mieke Van Hemelrijck, PhD, researcher and epidemiologist at King’s College in London, said during a press conference.
Van Hemelrijck and colleagues identified 30,642 patients using PCBaSe Sweden, a database based on the National Prostate Cancer Register of Sweden that includes data for more than 80,000 men with prostate cancer and covers 98% of locally advanced and metastatic prostate cancer incidence. Between 1997 and 2006, these patients received endocrine therapy as the primary treatment for their disease: 3,391 received antiandrogen therapy; 5,340 received orchiectomy; 9,066 received Gn-RH agonists; and 11,646 received Gn-RH agonists and short-term antiandrogen therapy.
The standardized incidence and mortality ratios were >1 for all heart disease subgroups. Though all three forms of endocrine therapy were associated with an increased risk for mortality from heart disease, antiandrogens were associated with the lowest risk. For example, the standardized incidence ratio for ischemic heart disease was 1.15 in the antiandrogen group (95% CI, 1.03-1.29) compared with 1.33 in the Gn-RH group (95% CI, 1.24-1.42).
“The lower risk increase for antiandrogen therapy might support the hypothesis that testosterone is protective for the heart,” Van Hemelrijck said. “When you give antiandrogens, the difference with other treatments is [the presence of] circulating testosterone in the body. It could be that the risk for antiandrogen therapy is less severe than others because there is still circulating testosterone.”
Patients with heart disease at baseline also had a lower risk for heart disease following endocrine therapy. The standardized incidence ratio for ischemic heart disease among patients with ischemic heart disease at baseline was 1.17 (95% CI, 1.11-1.24) compared with 1.41 for patients without ischemic heart disease at baseline (95% CI, 1.35-1.47).
Van Hemelrijck said future research is necessary, particularly when novel treatments become available, which would allow researchers to compare the treatments to determine whether endocrine therapy is the cause of the increased risk for heart disease.
For more information:
