Is Heart Disease Related to Hormone Therapy for Prostate Cancer?
by Jeni Crockett-Holme
Keywords: Prostate cancer, Hormone therapy, Heart disease, Radiation
Use of hormone therapy for prostate cancer has been associated with heart disease and diabetes. Some reports have suggested a relationship between hormone therapy and death from heart disease; others do not. As a precaution, the US Food and Drug Administration issued a safety warning about these possible risks.
With conflicting results, physicians and patients need clarity about whether using hormone therapy for prostate cancer will increase the risk of dying from heart disease.
Looking for clarity
This controversial problem was studied in a large group of North American men with prostate cancer that had not spread to other organs (localized disease) . Approximately one-fifth had risk factors for heart disease when they enrolled in the study. The men were treated for prostate cancer with radiation only or with radiation plus a short course of hormone therapy (for 4 months). Patients were followed after treatment for 9 years on average.
The results showed that men who received radiation plus hormone therapy had less risk of dying (from any cause) than men who received only radiation. In addition, those who received hormone therapy did not appear to have a higher risk of dying from heart disease. Risk of dying from heart disease was not associated with either treatment type or risk of dying from prostate cancer.
The study supported the use of hormone therapy in appropriate patients with localized prostate cancer.
This study is consistent with other studies that did not find an association between use of hormone therapy for prostate cancer and death from heart disease. Even men who had risk factors for heart disease when they entered the study were not at higher risk with hormone therapy treatment.
Hormone therapy did not increase risk of dying in this study, but it also did not increase the survival of men with low-risk prostate cancer, who were unlikely to die from their disease. Consequently, hormone therapy is not recommended for routine use in this group because the risk of additional side effects is not thought to be warranted.
This study is unique in that more than one-third of the patients had low-risk prostate cancer. The information on this group of patients is new.
The findings of this study suggest that hormone therapy for prostate cancer does not increase risk of death from heart disease and can be used with a survival benefit for appropriate patients.
 Voog JC, Paulus R, Shipley WU, et al. Cardiovascular Mortality Following Short-term Androgen Deprivation in Clinically Localized Prostate Cancer: An Analysis of RTOG 94-08. Eur Urol 2016;69:204–10.