Researchers find that a man's overall health profile , particularly cardiovascular health, should be evaluated and addressed prior to initiating androgen suppression therapy for prostate cancer
BOSTON - January 22, 2008 - Although androgen suppression therapy (AST) has been shown to increase the risk of cardiovascular events, the survival benefit it may offer to certain patients has been unclear. In a new study, researchers at Brigham and Women’s Hospital (BWH) have found that the addition of 6 months of AST to radiation therapy (RT) increased the overall survival rate of older men with localized, unfavorable-risk prostate cancer. Details of this study are published in the January 23, 2008 print edition of the Journal of the American Medical Association.
“This research helps to further refine the category of men that should receive androgen suppression therapy in addition to radiation therapy to improve their chance of survival,” says Anthony D’Amico, MD, PhD, a professor at Harvard Medical School, and lead author and chief of Genitourinary Radiation Oncology at Dana-Farber/Brigham and Women's Cancer Center.
Researchers evaluated men with a median age of 72 who had unfavorable localized prostate cancer and were randomized to receive either RT alone, or AST with RT. Researchers also subdivided the men into groups based on a comorbidity score that was determined by preexisting medical conditions and comorbidities before randomization of therapy. They report that in men who are otherwise healthy, the combination of RT and 6 months of AST improves curability 4-fold. However, in men with significant health issues unrelated to cancer, especially heart disease, which was the most common comorbidity in these men, adding AST to RT could have a reverse effect, doubling the overall death rate.
“Moving forward, randomized studies should be designed to assess whether new treatments being tested are beneficial to men when other significant health issues are present. However for now, an individual man's health profile should be evaluated and addressed, especially when pre-existing heart disease is present, before prescribing a treatment plan involving AST,” said D’Amico.
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Brigham and Women’s Hospital (BWH) is a 747-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare System, an integrated health care delivery network. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 800 physician-investigators and renowned biomedical scientists and faculty supported by more than $400M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative.