Prostate Cancer Therapy May Affect Heart and Bones

Although testosterone-lowering androgen deprivation therapy is an effective treatment for prostate cancer, it may raise the risk of men developing bone fractures and fatal cardiovascular disease.

A study in the medical journal Cancer says the likelihood of having either side effect remains low.

But the study does raise the question of how best to weigh the potential benefits of androgen deprivation therapy (ADT) against the potentially serious complications that could happen.

"It is important to point out that these adverse outcomes due to ADT are all preventable," says the study's lead author, Lockwood Taylor, at the University of Texas Health Science Center, "so it's up to a patient's doctor to be vigilant of changes in either cardiovascular or skeletal health that might develop as a result of the therapy."

Monitor Bone Density and Cholesterol

To assess side effects from ADT, Taylor and his colleagues reviewed 14 studies from 1966 to 2008 that focused on skeletal and cardiovascular side effects linked to ADT among men diagnosed with prostate cancer.

They found that ADT boosted the risk for overall fractures by 23 percent compared to men with prostate cancer not undergoing treatment.

Similarly, the chances of dying from heart disease were 17 percent higher among men with cancer on ADT than those who were not.

The researchers also mentioned two large studies that had indicated a substantial increase in the risk for developing diabetes among ADT patients.

"It would certainly be important to point out that, although we observed some statistically significant increases in the relative risk for these side effects, the absolute risks are still very low," Taylor stresses.

"But I would say that doctors should certainly monitor their patients on ADT for changes in bone mineral density, and, if they see a decrease, then they should consider some preventive therapies," he advises.

"They should also be vigilant for abnormal lipo [blood fat] profiles, in terms of cholesterol levels and serum levels of insulin, which are markers for both cardiovascular and skeletal fracture," Taylor adds.

He says that physicians could prescribe statin drugs to help lower cholesterol, while encouraging lifestyle changes to improve diet and physical activity.

Measuring Overall Risks

Dr. Nelson Neal Stone, at the Mount Sinai School of Medicine in New York City, says that the findings "reinforce what we already know.

"It's been well known for a while that ADT boosts a patient's risk for fracture, just like it happens among women who go on anti-estrogen therapy for breast cancer," Dr. Stone notes.

"And there have been several studies published in the last three to five years that find that men who go on the therapy are at an increased risk for all sorts of cardiovascular issues," he adds.

"While we all know that this therapy is needed to prevent the progression of metastases, it is true that while you are preventing a serious event on the one hand you are potentially putting the patient at risk," explains Dr. Stone.

"So the bottom-line is that we have to be careful about who we put on ADT," he says.

And research into preventive techniques needs to continue, Dr. Stone says, "because the therapy obviously entails some potentially severe side effects."

Always consult your physician for more information.