In a new study, researchers found that prolonged androgen deprivation therapy (ADT) can impair cardiorespiratory fitness and increase the risk of heart death in prostate cancer patients with a high risk of heart disease.
The findings support the need for heart disease monitoring in patients who are living longer after successful cancer treatment.
Approximately 1 in 9 men will be diagnosed with prostate cancer during their lifetime, and it is the second leading cause of cancer death for men in the United States.
Furthermore, heart disease is a leading cause of death in men who have a history of prostate cancer.
ADT with radiation therapy is a standard primary treatment for prostate cancer as an alternative to surgery and is frequently used in patients with metastatic, recurrent, and localized high-risk tumors.
More prolonged use of ADT in certain patients with prostate cancer is increasingly used following studies that demonstrated improved cancer outcomes compared to short-term ADT exposure.
However, whether ADT is linked to increased cancer mortality remains controversial.
In the study, the team examined 616 patients who did an exercise treadmill test for clinical indications a median of 4.8 years after their prostate cancer diagnosis.
Almost one-quarter of the patients (150) received ADT prior to their treadmill test, with 51 patients exposed to long-term ADT use (more than 6 months).
There were 504 patients (81.8%) who had two or more heart disease risk factors, such as diabetes and high blood pressure. Most patients with prolonged exposure to ADT (92.2%) had two or more heart disease risk factors.
The team found reduced heart fitness was much higher among patients with ADT treatment compared to those without the treatment (48.7% versus 32.6%).
Prolonged ADT treatment was strongly linked to reduced heart fitness. Long-term ADT exposure was linked to an almost four-fold increased risk of heart disease mortality.
This study highlights that patients with prostate cancer and high heart disease risk are at increased risk of reduced heart fitness and death risk when exposed to prolonged ADT treatment.
While prolonged ADT certainly plays a role in the treatment of prostate cancer, these findings emphasize the need to consider heart disease surveillance during and after ADT exposure.
One author of the study is John D. Groarke, MBBCh, MSc, MPH, cardiologist.
The study is published in JACC: CardioOncology.
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