Stress after prostate cancer diagnosis leads to cardiovascular events

SAN FRANCISCO – As little as one week after being diagnosed with prostate cancer, patients are at increased risk for fatal and non-fatal cardiovascular events.

The risk is most prominent within the first week after diagnosis, among men without a prior history of cardiovascular disease and among younger men, said Fang Fang, MD, a doctoral student in the department of medical epidemiology and biostatistics at Karolinska Institutet in Sweden. Fang presented the study data at the 2008 Genitourinary Cancers Symposium.

Fang and colleagues conducted a cohort study of Swedish men using Census information and followed up with the men until one year after diagnosis of prostate cancer, death, emigration or end of 2004.

The researchers identified 168,584 prostate cancer cases from the Swedish Cancer Register. Among this group, they found 7,429 incidents of fatal cardiovascular events within the first year after diagnosis (1961-2004), and 3,655 incidents of non-fatal cardiovascular events (1990-2004). Compared with men who were not diagnosed with prostate cancer, the relative risk of fatal cardiovascular events in the first year after diagnosis was about 50% higher and the relative risk of non-fatal events was about 30% higher among the prostate cancer patients, Fang told HemOnc Today.

“Men diagnosed with prostate cancer are at an increased risk for both cardiovascular morbidity and death within the first year after diagnosis compared with men without a diagnosis,” Fang said during her presentation. “This forms a hypothesis of stress-induced health consequences.” – by Emily Shafer

For more information:
Fang F, Fall K, Mucci L, Valdimarsdottir U, et al. #12. Presented at: 2008 Genitourinary Cancers Symposium; Feb. 14-16, 2008; San Francisco.

This suggests that just being diagnosed induces a state that could lead to myocardial infarction, even within one week after diagnosis before any treatment. Intuitively, it makes sense since receiving such a diagnosis is stressful. The affected men likely have some type of predisposition in their coronary arteries, but their risk factors have not been discovered yet. There is not enough evidence to actually change practice and recommend routine cardiovascular screening for patients, but that would be an interesting follow-up study.

– Howard Sandler, MD

Newman Family Professor & Senior Associate Chair, Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Mich.