Cardiac Disease Incidence Rises Early After Starting Androgen Deprivation Therapy
NEW YORK (Reuters Health) Oct 26 - Among men with prostate cancer, treatment with androgen deprivation therapy (ADT) is associated with a higher incidence of heart disease within the first 12 months of treatment.
Thus, men with low-risk prostate cancer who receive \"ADT for even a short duration may actually experience decreased overall survival as a result of this intervention,\" Dr. Christopher Saigal and co-authors warn in the October 1st issue of Cancer.
Multiple lines of evidence - animal models, population-based and cross-sectional studies, and controlled clinical trials - support the association between androgens and cardiovascular health, the investigators note. This association is particularly relevant, the authors add, given the increasing use of hormonal therapy in prostate cancer.
To shed further light on these associations, Dr. Saigal, a urologist at the University of California at Los Angeles, and associates linked databases from the SEER national cancer registry and Medicare claims files. Study subjects were diagnosed with primary prostate cancer between 1992 and 1996 and followed for 5 years.
The researchers identified nearly 23,000 subjects, among whom 21% received ADT. Treatment with ADT for at least 1 year was associated with a 20% higher risk of serious cardiovascular morbidity.
\"These data have particular relevance to decisions regarding the use of ADT in men with prostate cancer in settings in which the benefit has not been clearly established,\" such as primary treatment in cases of localized prostate cancer, the investigators suggest.
ADT is considered the \"mainstay of therapy\" among men with metastatic prostate cancer because it reduces cancer-related mortality, Dr. Saigal's group points out. Nevertheless, cardiovascular disease remains the most common cause of death among men with prostate cancer who do not die of their malignancy.
\"For men with metastatic disease, focused efforts to reduce cardiac risk factors through diet, exercise, or lipid-lowering agents may mitigate some of the risks of ADT,\" the investigators advise.
Cancer 2007;110:1493-1500. |
发表于 2007-11-3 17:08:55