Seniors May Increase Risk of Heart Disease from Prostate Cancer Treatment

Longer they received ADT, the sooner they were likely to die

Feb. 26, 2007 - One of the most common treatments for prostate cancer -
androgen deprivation therapy - may increase the risk of death from heart
disease in senior citizens over age 65, according to a new study by
researchers at Dana-Farber Cancer Institute, Brigham and Women's Hospital
and other institutions.

Although the findings need to be confirmed in clinical trials, the study
authors state that oncologists should weigh the benefits of androgen
deprivation therapy, or ADT, against the risk of heart problems in older
prostate cancer patients. The study results were based on data from CaPSURE,
a national registry of men with prostate cancer.

The researchers presented their study at the Prostate Cancer Symposium in
Orlando, Fla., on Saturday. The symposium is sponsored by the American
Society of Clinical Oncology, the American Society for Therapeutic Radiology
and Oncology and the Society of Urologic Oncology.

The goal of ADT is to block the level of circulating androgens (male
hormones), which can fuel the growth of prostate cancers. "Androgen
deprivation therapy is associated with elevated body mass index, increased
body fat deposits and diabetes, all of which raise the risk of death from
heart diseased," explains the study's lead author, Henry Tsai, MD, a
resident physician at Dana-Farber, Brigham and Women's and the Harvard
Radiation Oncology Program.

"Although our findings demonstrated that older men receiving this treatment
may be at increased risk, even after taking into account other
cardiovascular risk factors, a prospective clinical trial would be needed to
confirm a cause-and-effect relationship."

Drawing on the CaPSURE database, Tsai and his colleagues compared the number
of cardiac-related deaths among 735 men with localized prostate cancer who
received ADT and among 2,901 men with the disease whose treatment did not
include ADT.

After factoring in other known risks for cardiovascular disease (such as
diabetes, hypertension, body mass index and smoking), researchers found that
the longer patients received ADT, the sooner they were likely to die from
heart disease. When the researchers analyzed the data by patients' age, the
link between ADT use and death from heart disease was significant in
patients over age 65, but not in those under 65. After five years, 3 percent
of older men who received androgen deprivation therapy died of cardiac
causes, compared with only 0.9 percent of men who did not receive the
therapy.

"These findings should help oncologists determine which older patients are
the best candidates for ADT," Tsai remarks. "If a patient is at high risk of
cardiovascular disease, it would be advisable for an oncologist to discuss
the pros and cons of ADT treatment with him before proceeding on a course of
treatment."

Editor's Notes:

Co-authors of the study include Anthony D'Amico, MD, PhD, of Dana-Farber and
Brigham and Women's, Ming-Hui Chen, PhD, of the University of Connecticut,
and Natalia Sadetsky, MD, MPH, and Peter R. Carroll, MD, both of the
University of California, San Francisco.

The CaPSURE database is a research collaboration between TAP Pharmaceutical
Products, Inc., and the University California, San Francisco, Department of
Urology. The study was funded in part by the CaPSURE Scholars Program in
Prostate Cancer Outcomes Research.

Dana-Farber Cancer Institute (www.danafarber.org) is a principal teaching
affiliate of the Harvard Medical School and is among the leading cancer
research and care centers in the United States. It is a founding member of
the Dana-Farber/Harvard Cancer Center (DF/HCC), designated a comprehensive
cancer center by the National Cancer Institute.

Brigham and Women's Hospital is a 747-bed nonprofit teaching affiliate of
Harvard Medical School and a founding member of Partners HealthCare System,
an integrated health care delivery network. BWH is committed to excellence
in patient care with expertise in virtually every specialty of medicine and
surgery. The BWH medical preeminence dates back to 1832 and today that rich
history in clinical care is coupled with its national leadership in quality
improvement and patient safety initiatives, dedication to educating and
training health care professionals, and strength in biomedical research.
With $370M in funding and more than 500 research scientists, BWH is an
acclaimed leader in clinical, basic and epidemiological investigation -
including the landmark Nurses Health Study, Physicians Health Studies, and
the Women's Health Initiative. For more information about BWH, please visit:
www.brighamandwomens.org.