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Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
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Friday, June 8, 2007
Study suggests men at risk for heart attack should be evaluated before starting hormones for prostate cancer
Men who are at risk for a fatal heart attack should be evaluated by a cardiologist before beginning hormonal therapy to treat prostate cancer, researchers from Harvard Medical School report.
The article to appear Sunday in the Journal of Clinical Oncology follows a landmark paper by other Harvard doctors published last fall in the same journal (and reported in the Globe) that linked androgen suppression therapy to diabetes and heart disease.
Androgen suppression therapy is often prescribed for men with prostate cancer. Research has established that it improves survival rates in men with advanced stages of the disease when given with radiation therapy, but the benefits of the treatment are not as clear in men whose cancer is in earlier stages.
In the newer work, researchers led by Dr. Anthony V. D'Amico of Harvard and Brigham and Women's Hospital analyzed data from three randomized trials of 1,372 men in Australia and New Zealand, Canada and the United States. They report that nearly half of the men who were 65 and older and had heart disease risk factors suffered heart attacks sooner if they had received androgen suppression therapy for six months compared to men who had not been given the therapy.
Men who smoke or have diabetes, which put them at risk for heart attacks, should be referred for a cardiac evaluation before they start hormonal therapy to treat prostate cancer, D'Amico said in an interview.
"The study shows that a significant fraction of these men who are going to have heart attacks will have them on average 2 to 3 years sooner if the underlying heart disease is not addressed," he said.
D'Amico said his study's results "fit perfectly " with data produced by Dr. Nancy L. Keating of Brigham and Women's and Dr. Matthew R. Smith of Massachusetts General Hospital. They found that among 73,000 Medicare patients, men who received hormonal therapy significantly increased their risk of developing diabetes and also raised their risk of heart disease.
"The landmark study by Keating put on the map the issue of treatment-related diabetes and cardiovascular disease," Smith said. "Great care needs to be taken in interpreting the results of other trials because of the relatively small number of events and because the studies weren't designed to look at cardiovascular disease."
D'Amico said men can safely delay hormonal therapy to seek treatments for heart disease, which can range from taking aspirin to having stents placed to prop open clogged coronary arteries.
"Hormone therapy can cause a heart attack sooner than prostate cancer can progress," he said.