Many men with prostate cancer are treated with hormones that block the effects of testosterone, the primary male sex hormone. This is because many prostate cancers thrive on testosterone.
By depriving them of testosterone, the prostate cancer cells “starve” and die. This treatment is called androgen suppression therapy. Usually, it is men with aggressive prostate cancer and those with prostate cancers that cause the prostate gland to enlarge who benefit the most from androgen suppression therapy.
Nearly every treatment that has benefits also has risks. Physicians must always weigh the benefits and risks of a treatment. Of course, the potential of androgen suppression therapy to prolong the life of men with prostate cancer and even increase the likelihood of it being cured cannot be disregarded. Nonetheless, the side effects of androgen suppression therapy include the loss of sex drive, anemia, osteoporosis, weight gain, decreased muscle mass, increase in bad cholesterol (LDL) and decrease in good cholesterol (HDL).
The alteration of LDL and HDL by androgen suppression therapy can potentially increase the risk of coronary artery disease and heart attacks. Therefore, this possibility was analyzed from data pooled from three randomized studies performed in the United States, Australia, and New Zealand, respectively.
One thousand three hundred seventy two (1, 372) men who received androgen suppression therapy in addition to radiation therapy to the prostate gland were followed for at least five years. The researchers found that men over 65 who received androgen suppression therapy for six months had an earlier onset of heart attacks, perhaps by two and a half years.
Does this mean men should not be treated with androgen suppression therapy, especially in the group in whom the benefits of hormonal therapy outweigh the risks? It does not; instead, the implication is that men who will benefit from hormonal therapy to avoid dying from prostate cancer but who also have risk factors for coronary artery disease should be referred to a cardiologist.
Men can then be assessed for and even treated for heart disease before they begin hormonal therapy. They can then undergo androgen suppression therapy without adverse effects on their hearts.
Also, more good news is that new studies are being developed to determine the optimal duration of androgen suppression therapy. By making hormonal therapy intermittent, such as six months on androgen suppression therapy and six months off, men might achieve the same survival endpoint with less toxicity than continuous androgen suppression therapy.