Many men with prostate cancer are treated with hormones that block the effects of testosterone, the main male sex hormone. This is because many prostate cancers thrive on testosterone.
By depriving them of testosterone, prostate cancer cells “starve” and die. This treatment is called androgen suppression therapy. Generally, men with aggressive prostate cancer and those with prostate cancers that cause the prostate gland to enlarge benefit the most from androgen suppression therapy.
Almost all treatments that have benefits also have risks. Doctors must always weigh the benefits and risks of a treatment. Of course, the potential for androgen suppression therapy to prolong the lives of men with prostate cancer and even increase the likelihood that it will be cured cannot be ignored. However, the side effects of androgen suppression therapy include loss of sexual desire, anemia, osteoporosis, weight gain, decreased muscle mass, increased bad cholesterol (LDL), and decreased good cholesterol (HDL).
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 explored using pooled data from three randomized studies conducted 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 older than 65 who received androgen suppression therapy for six months had an earlier onset of heart attacks, perhaps two and a half years.
Does this mean that men should not be treated with androgen suppression therapy, especially in the group where the benefits of hormone therapy outweigh the risks? It is not like this; Instead, the implication is that men who will benefit from hormone therapy to avoid dying from prostate cancer but who also have risk factors for coronary artery disease should be referred to a cardiologist.
The men can then be evaluated and even treated for heart disease before starting hormone therapy. They can then undergo androgen suppression therapy with no ill effects on their hearts.
In addition, other good news is that new studies are being developed to determine the optimal duration of androgen suppression therapy. By making hormone therapy intermittent, such as six months of androgen suppression therapy and six months of inactivity, men could achieve the same survival endpoint with less toxicity than continuous androgen suppression therapy.