Hormone Therapy Ups All-Cause Mortality in Older Men With Localized Prostate Cancer

by Michelle Rizzo | Medscape.com | 01.14.2010

In men with localized prostate cancer who are in their mid-70s or older, adding neoadjuvant hormone therapy (NHT) to brachytherapy significantly increases all-cause mortality, researchers report in the January 5th online issue of Cancer.

This study "builds on a growing body of literature" that suggests NHT, even of short duration, appears to put a small subset of men at an increased risk for death -- not from prostate cancer, but from the interaction of the NHT with some other underlying illness, senior author Dr. Anthony V. D'Amico, of Harvard Medical School, Boston, told Reuters Health.

Dr. D'Amico and his colleagues examined the effect of NHT on mortality in 2,474 men (median age: 73 years) with localized prostate cancer who were treated between 1991 and 2005. All received brachytherapy; 1,083 also received NHT.

Sixty-five percent had low-risk disease, 23% were intermediate-risk, and 12% were high-risk. All were followed for at least two years.

During a median follow-up of 4.8 years, 643 of the men (26%) died. NHT was significantly linked to increased all-cause mortality in men aged 73 or older (adjusted hazard ratio: 1.24; p = 0.04), but not in younger men.

Known prostate cancer prognostic factors were not associated with risk of all cause mortality.

The paper does not address the specific causes of death in the study subjects. However, Dr. D'Amico said, "There is a direct association between age greater than 70 and the presence of cardiovascular disease, and so it is our presumption that this is what the driving force is behind the increased mortality seen in this study. That is, these men were more likely to have coronary artery disease and therefore when they were exposed to the hormonal therapy, they were more likely to have a cardiac event."

He noted that the mechanism by which hormonal therapy causes these cardiac events is not known.

"For men who require hormonal therapy for treatment of their prostate cancer, some form of cardiac evaluation, yet to be determined, should be done," Dr. D'Amico said.

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