Risk of cardiovascular events in men treated for PCa.

[pjoshea13]

New Danish study [1] & a new paper from Mark Moyad [2].

"Men who received first-line palliative treatment had {twice the risk} of {ischaemic stroke} and {heart failure}" ... "compared with PCa-free men." "Pre-diagnosis lifestyle, anthropometry or cardiovascular risk factors did not explain the risk ..."

IMO, they should have done separate comparisons for those who did have risk factors & those who didn't.

Anyway, it is recognized that men with PCa have a greater risk of CVD, regardless of treatment, but more so with ADT. Dr. Myers was dismayed that new patients came to him with CVD symptoms unaddressed by their regular doctors. He said that he spent as much time preventing death from CVD as he did from PCa.

I think that men with PCa are so preoccupied by PCa that they pay little attention to CVD. And perhaps, in the back of their minds, some would welcome a sudden death by CVD than a frightening death from PCa.

Personally, I would like to avoid both. What's the point of trying to increase PCa survival if all-cause survival is crap.

Mark Moyad has written that "Heart healthy is prostate healthy, but heart unhealthy is prostate unhealthy." [2]

He has been saying this for twenty years [3].

-Patrick

[1]

Br J Cancer. 2019 May 8. doi: 10.1038/s41416-019-0468-8. [Epub ahead of print]

Risk of cardiovascular events in men treated for prostate cancer compared with prostate cancer-free men.

Moustsen IR1, Larsen SB2,3, Duun-Henriksen AK4, Tjønneland A5,6, Kjær SK7, Brasso K3, Johansen C2,8, Dalton SO2,9.

Author information

1

Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark. [e-mail].

2

Survivorship, Danish Cancer Society Research Center, Copenhagen, Denmark.

3

Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

4

Statistics and Pharmaco-epidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark.

5

Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark.

6

Department of Public Health, University of Copenhagen, Copenhagen, Denmark.

7

Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.

8

The Oncology Clinic, Finsen Center, Rigshospitalet 5073, 2100 Copenhagen, University of Copenhagen, Copenhagen, Denmark.

9

Department of Oncology, Zealand University Hospital Naestved, Naestved, Denmark.

Abstract

BACKGROUND:

The effect of lifestyle, anthropometry and cardiovascular risk factors on cardiovascular disease in men with prostate cancer (PCa) remains unclear.

METHODS:

Using a population-based cohort of 25,436 Danish, cancer-free men aged 50-64 years, we obtained information on self-reported pre-cancer lifestyle, objectively measured anthropometry and cardiovascular risk factors, and linked them to national health registers for information on major cardiovascular outcomes. We assessed hazard ratios (HRs) of incident acute myocardial infarction (MI), ischaemic stroke (IS) and heart failure (HF) among 1546 men diagnosed with PCa treated with first-line active surveillance, watchful waiting, intended curative or palliative treatment compared with PCa-free men during 18 years of follow-up.

RESULTS:

Men who received first-line palliative treatment had higher rates of IS and HF with adjusted HRs of 2.09 (95% CI 1.49-2.93) and 2.05 (95% CI 1.43-2.94), respectively, compared with PCa-free men. The risks were increased from start of treatment. We did not find the same relation for men in any other treatment group. No differences between men treated for PCa and cancer-free controls were observed for MI after adjustment for lifestyle, anthropometry, and cardiovascular risk factors.

CONCLUSION:

Pre-diagnosis lifestyle, anthropometry or cardiovascular risk factors did not explain the risk of IS and HF in PCa patients receiving palliative treatment. The results emphasise the need for balancing disease management and monitoring of cardiovascular health in this patient group.

PMID: 31065112 DOI: 10.1038/s41416-019-0468-8

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[2] ncbi.nlm.nih.gov/pubmed/303...

Curr Urol Rep. 2018 Oct 27;19(12):104. doi: 10.1007/s11934-018-0846-4.

Preventing Lethal Prostate Cancer with Diet, Supplements, and Rx: Heart Healthy Continues to Be Prostate Healthy and "First Do No Harm" Part I.

Moyad MA1.

Author information

1

University of Michigan Medical Center, Ann Arbor, MI, USA. [e-mail].

Abstract

PURPOSE OF REVIEW:

To discuss the overall and latest observations of the effect of diet, lifestyle, supplements, and some prescription heart healthy medications for prostate cancer prevention.

RECENT FINDINGS:

The concept of maximizing heart health to prevent aggressive prostate cancer continues to be solidified with the addition of more prospective observational and randomized controlled trial data. Heart healthy is prostate healthy, but heart unhealthy is prostate unhealthy. The primary goal of reducing the risk of all-cause and cardiovascular disease (CVD) morbidity and mortality also allows for maximizing prostate cancer prevention. The obesity epidemic in children and adults along with recent diverse research has only strengthened the nexus between heart and prostate health. Greater dietary adherence toward a variety of healthy foods is associated with a graded improved probability of CVD and potentially aggressive cancer risk reduction. Preventing prostate cancer via dietary supplements should encourage a "first do no harm", or less is more approach until future evidence can reverse the concerning trend that more supplementation has resulted in either no impact or an increased risk of prostate cancer. Supplements to reduce side effects of some cancer treatments appear to have more encouraging data. Medications that improve heart health including statins, aspirin, and metformin (S.A.M.), and specific beta-blocker medications are primarily generic or low-cost and should continue to garner research interest. A watershed moment in medical education has arrived where the past perception of a diverse number of trees seemingly separated by vast distances, in reality, now appear to exist within the same forest.

KEYWORDS:

Cardiovascular disease; Diet; Prostate cancer prevention; S.A.M.

PMID: 30368693 DOI: 10.1007/s11934-018-0846-4

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[3] ncbi.nlm.nih.gov/pubmed/?te...

[Philly13]

Thank you for sharing these studies and thoughts. My father died from Pca 35 years ago this month at the age of 60. It was a different time, of course. Nevertheless, the deterioration of his health from the treatments was profound and left an indelible mark on my psyche. I have Gleason 9 aggressive disease. I became a vegan within 1 week of diagnosis and have no regrets. The health of all systems is important and will help in the battle. I disagree with those on the site who say that if you have the disease why bother pushing yourself to eat healthy when there is no proven link to effective results in the fight against cancer specifically. I will read the reference materials more carefully and continue to stick with a mostly vegan lifestyle. My tastes have changed in the last year and half anyway. Broccoli looks to me like a hamburger used to and a hamburger looks like broccoli. ( I am only half kidding).

[cesanon in reply to Philly13]

I have cut down on meat, but not eliminated it, because of concerns that eliminating it entirely might be as bad as having to much.

[Sherpa111 in reply to Philly13]

Could not agree more. Mostly plant based, some fish 3 or 4 times a week. I was never really a meat eater anyway and yet I still contacted stage 4 PC (bones and lymph nodes all the way from my groin to my neck). Anyway. I eat plants. Good luck to you!

[j-o-h-n in reply to Philly13]

And what does a Philly steak look like to you? (I am only whole kidding).

Happy Mother's Day.

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 05/12/2019 12:25 AM DST

[Fairwind]

I must agree that at some point the treatments offered degrade quality of life more than the cancer itself.. Are the benefit offered by these treatments worth the debilitating side effects ?

[snoraste]

I read somewhere that besides the cancer itself, CVD is the second leading cause of death for patients with PCa. So I have been looking for studies that better quantify CVD, and also All Cause vs Cancer Specific mortality numbers by staging for PCa. I have not found many - just anecdotally here and there. Even Latitude/Stampede only show AllCause.

[Hidden]

All I can say is separated by 40 miles and no prior working relationship, my Cardiologist worked with my Medical Oncologist and shared data.

GD

[Adam10]

Thank you for posting this Patrick. I am one who was focusing on PCa to the exclusion of most other things including CVD - except for my hypothyroidism but that seems minor compared to PCa.

I researched “first-Line palliative treatment” for PCa but could not find clarification. This may be because I find it hard to concentrate or (bizarrely) to persevere on such things when the news might be bad - hoping it will go away.

Grateful if you could clarify.

[pjoshea13 in reply to Adam10]

Adam,

I believe they mean basic ADT, such as Lupron. With no added Zytiga/Xtandi, for example.

-Patrick