ADT for Prostate Cancer and Risk of Cardiac Disease

Prostate cancer, one of the most common malignancy in males and is strongly linked to the testosterone hormone. Therefore, one of the common approaches to address prostate malignancy is to inhibit the peripheral activity of testosterone by ADT or androgen deprivation therapy. ADT is known to exert its action by reducing the concentration of circulating testosterone to slow down the tumor growth.Although not well-established, it is also believed that the efficacy and benefits of radiation therapy can be improved by combining it with ADT. In fact, it is now being increasingly used to manage small, localized malignancies of the prostate gland.

What are some side effects of ADT?

A lot of research is being done to evaluate the pros and cons of ADT in the management of prostate cancer. Some common side effects associated with androgen deprivation therapy are:

1. Loss of bone mass and density
2. Diabetes
3. Erectile dysfunction
4. Dementia or cognitive decline
5. Alzheimer’s disease
6. Gynecomastia (or swollen breast tissue)

Most side effects of androgen deprivation therapy can be explained by low serum testosterone levels.

ADT and Cardiovascular Disease – are they related?

There are several studies that suggest a strong link between ADT and risk of developing cardiovascular disease. For example; according to a new study, the risk of developing non-fatal cardiac disease increases by up to 40% in men who have received androgen deprivation therapy for the management of prostate cancer.There is some degree of conflicting evidence too since so many environmental, genetical and hormonal factors play a role in the pathogenesis of cardiac disease – it is hard to pinpoint if cardiovascular disease is caused by any one factor alone. In addition, since heart condition is usually silent; it is difficult to ascertain that the cardiovascular dysfunction diagnosed after ADT is actually caused by ADT as well.

Details of the Study:

After carefully analyzing several associated risk factors (also referred to as confounding factors), the team of researchers included 7,637 men in a prospective study with a recent history of localized prostate malignancy. Of these men, about 1/3^rd were found to have received ADT for cancer management.These men were then followed for a period of 13 years.After controlling for several confounding factors such as a history of smoking, abnormal BMI, prior history of cardiac disease or cardiac risk factors, and certain medications; investigators discovered that ADT alone after prostate malignancy increases the risk of developing a cardiac disease or heart failure by 81%. In addition, those with a history of CVD, risk of developing cardiac rhythm abnormalities increases by 44%Most of the negative implications of cardiovascular dysfunction in the setting of prostate cancer are a result of low serum testosterone levels that negatively impact the serum lipid levels.The results of this study were published in the British Journal of Cancer.References:

1. Gandaglia, G., Sun, M., Popa, I., Schiffmann, J., Abdollah, F., Trinh, Q. D., ... & Karakiewicz, P. I. (2014). The impact of androgen‐deprivation therapy (ADT) on the risk of cardiovascular (CV) events in patients with non‐metastatic prostate cancer: a population‐based study. BJU international, 114(6b).
2. Jespersen, C. G., Nørgaard, M., & Borre, M. (2014). Androgen-deprivation therapy in treatment of prostate cancer and risk of myocardial infarction and stroke: a nationwide Danish population-based cohort study. European urology, 65(4), 704-709.

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