| Causes, prevention and humane, up-to-date treatment Real-life research by Al Smith and Faith Warn |
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Harvard study reveals urgent need for
PCa rethink
19th September 2006
Prostate cancer treatment increases risk of diabetes and heart
disease. Physicians and patients should be aware of potential
risks associated with GnRH agonist therapy
BOSTON -- A treatment mainstay for prostate cancer puts men
at increased risk for diabetes and cardiovascular disease,
according to a large observational study published in the Sept.
20 Journal of Clinical Oncology.
"Men with prostate cancer have high five-year survival rates,
but they also have higher rates of non-cancer mortality than
healthy men," says study author Nancy Keating, MD, MPH,
assistant professor of health care policy and of medicine at
Harvard Medical School. "This study shows that a common
hormonal treatment for prostate cancer may put men at
significant risk for other serious diseases. Patients and
physicians need to be aware of the
elevated risk as they make treatment decisions."
The principal systemic therapy for prostate cancer involves
blocking testosterone production. This is done either by
removal of the testes (bilateral orchiectomy), or more
commonly, by regular injections of a gonadotropin-releasing
hormone (GnRH) agonist drug. GnRH agonists are the main
therapy for metastatic prostate cancer and may also improve
survival for some men with locally-advanced cancers.
However, little is known about the efficacy of GnRH agonists in
treating men with less-advanced local or regional prostate
cancer, many of whom receive this therapy. Earlier studies
have found GnRH agonists to be associated with obesity and
insulin resistance, a precursor to diabetes.
Diabetes and heart risk
"Our study found that men with local or regional prostate
cancer receiving a GnRH agonist had a 44 percent higher risk
of developing diabetes and a 16 percent higher risk of
developing coronary heart disease than men who were not
receiving hormone therapy," says Keating, who is also a
physician at Brigham and Women's Hospital.
"Doctors should think twice about prescribing GnRH agonists
in situations for which studies have not demonstrated
improved survival until we better understand the risks of
treatment," says co-author Matthew Smith, MD, PhD, associate
professor of medicine at HMS and a medical oncologist at
Massachusetts General Hospital. "For men who do require this
treatment,physicians may want to talk with their patients about
strategies, such as exercise and weight loss, which may help
to lower risk of diabetes and heart disease."
Given the number of men receiving GnRH agonists, often for
many months or years, these increased risks can have
important implications for the health of prostate cancer
survivors, says Keating. Additional studies are needed to fully
understand the biological mechanisms responsible for these
increased risks.
Prostate cancer is the most frequently diagnosed cancer
among men, affecting more than 200,000 men in the United
States every year. With prostate cancer's favorable prognosis,
however, decisions about treatments are particularly important
because adverse effects and complications of treatments may
impact overall health and quality of life more than prostate
cancer itself.
The study assessed whether androgen deprivation therapy
was associated with an increased incidence of diabetes,
coronary heart disease, myocardial infarction, or sudden
cardiac death by examining data from approximately 73,000
men age 66 or older who were diagnosed with local or regional
prostate cancer
This work was supported by the Prostate Cancer Specialized
Program of Research Excellence (SPORE) of the National
Cancer Institute, one of the National Institutes of Health.
HARVARD MEDICAL SCHOOL: http://hms.harvard.edu/
PCa rethink
19th September 2006
Prostate cancer treatment increases risk of diabetes and heart
disease. Physicians and patients should be aware of potential
risks associated with GnRH agonist therapy
BOSTON -- A treatment mainstay for prostate cancer puts men
at increased risk for diabetes and cardiovascular disease,
according to a large observational study published in the Sept.
20 Journal of Clinical Oncology.
"Men with prostate cancer have high five-year survival rates,
but they also have higher rates of non-cancer mortality than
healthy men," says study author Nancy Keating, MD, MPH,
assistant professor of health care policy and of medicine at
Harvard Medical School. "This study shows that a common
hormonal treatment for prostate cancer may put men at
significant risk for other serious diseases. Patients and
physicians need to be aware of the
elevated risk as they make treatment decisions."
The principal systemic therapy for prostate cancer involves
blocking testosterone production. This is done either by
removal of the testes (bilateral orchiectomy), or more
commonly, by regular injections of a gonadotropin-releasing
hormone (GnRH) agonist drug. GnRH agonists are the main
therapy for metastatic prostate cancer and may also improve
survival for some men with locally-advanced cancers.
However, little is known about the efficacy of GnRH agonists in
treating men with less-advanced local or regional prostate
cancer, many of whom receive this therapy. Earlier studies
have found GnRH agonists to be associated with obesity and
insulin resistance, a precursor to diabetes.
Diabetes and heart risk
"Our study found that men with local or regional prostate
cancer receiving a GnRH agonist had a 44 percent higher risk
of developing diabetes and a 16 percent higher risk of
developing coronary heart disease than men who were not
receiving hormone therapy," says Keating, who is also a
physician at Brigham and Women's Hospital.
"Doctors should think twice about prescribing GnRH agonists
in situations for which studies have not demonstrated
improved survival until we better understand the risks of
treatment," says co-author Matthew Smith, MD, PhD, associate
professor of medicine at HMS and a medical oncologist at
Massachusetts General Hospital. "For men who do require this
treatment,physicians may want to talk with their patients about
strategies, such as exercise and weight loss, which may help
to lower risk of diabetes and heart disease."
Given the number of men receiving GnRH agonists, often for
many months or years, these increased risks can have
important implications for the health of prostate cancer
survivors, says Keating. Additional studies are needed to fully
understand the biological mechanisms responsible for these
increased risks.
Prostate cancer is the most frequently diagnosed cancer
among men, affecting more than 200,000 men in the United
States every year. With prostate cancer's favorable prognosis,
however, decisions about treatments are particularly important
because adverse effects and complications of treatments may
impact overall health and quality of life more than prostate
cancer itself.
The study assessed whether androgen deprivation therapy
was associated with an increased incidence of diabetes,
coronary heart disease, myocardial infarction, or sudden
cardiac death by examining data from approximately 73,000
men age 66 or older who were diagnosed with local or regional
prostate cancer
This work was supported by the Prostate Cancer Specialized
Program of Research Excellence (SPORE) of the National
Cancer Institute, one of the National Institutes of Health.
HARVARD MEDICAL SCHOOL: http://hms.harvard.edu/
