After making suitable adjustments to the data, the researchers found:
o - a more than two-fold increase in the risk of death from cardiovascular disease in men who had received hormone therapy.
o - a higher risk of cardiovascular disease-related death from the second year onwards following a prostate cancer diagnosis.
o - an almost five-fold higher risk in the 70 to 79 age group of those who received hormone therapy compared to those who did not.
The team also assessed the risk of death from several subtypes of cardiovascular disease, identifying there was a higher risk of dying specifically from stroke or coronary heart disease. These risks were 42% and 70% higher, respectively, in men treated with hormone therapy compared to those who were not.
Of particular significance, IMHO was the almost 5-fold increase of cardiac incidents in men over 70 being treated with ADT when compared to men who were not treated with ADT. I imagine that possibly has something to do with me now having 6 stents.
Worth discussing with your oncologist perhaps before starting ADT...
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Don_1213
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Allen. I thought about that this AM while showering (deep thoughts usually arrive with warm water running over my head for some reason..) I agree entirely - relative vs absolute should be considered in making any decision. But - the 5 fold increase still might be concerning. Let me 'splain..
If as some of the numbers indicate - cardio incidences "double", that might be an increase from 1% to 2% (or even 0.1% to 0.2%) - and that has to be balanced against the benefit of the ADT and the potential increase in metastasis-free survival due to the use of ADT. It becomes a numbers match.
Which one ends up with a greater number of survivors after XX time.
The 5 fold increase to me could be concerning - if it was from 1% to 5%. In that case the benefit of ADT has to be balanced against the potential for cardio problems due to the ADT.
Just from memory (notoriously inaccurate) - ADT in high-risk cases of PCa has a benefit of an increase of metastasis-free survival of several percent (perhaps as high as 5-10% - but that's from memory not from hard data.) IIRC it offers a good deal less of an advantage in cases of low-risk PCa (and is often not used, or not used for very long.)
That's where discussion with an oncologist would be worthwhile... a simple risk vs potential rewards decision (which isn't simple - a lot depends on the patient), but it deserves discussion before starting therapy.
Men on this site who are doing ADT are on lifelong ADT. The hazard ratio for all the approved advanced hormonal therapies are in the range of 25%-50% increase in survival. The hazard for a non-fatal CV event is under 5% (fatal CV events are negligible) - the choice is obvious.
I agree - generally - but still suggest talking to both your medical oncologist and your cardiologist. For men with pre-existing cardiac issues the risk factor may well become significant, above the 5% number. If you don't have either of these MD's on your team, you should start considering them.
BTW - I did post here in this forum on purpose, since I've seen men reporting receiving ADT for very low-risk cases of PCA (G6, G7), and in those cases, the benefit of ADT not only is lower but may actually be negative.
"An educated consumer.. " (who was it who said that? I do remember, but you'd have to listen to NYC radio in the 70's to know..) "is our best customer.."
As a former medical journalist, I appreciate your remark about relative vs. absolute risk -- a point missed by many news organizations in reporting scientific findings.
The stats bear this out - it is a low COMPARABLE risk. I guess if you have already had a cardiac issue history you should bring this up. But of course - what is the risk of NOT going on ADT?
ADT is hard on the body. Pretty much everyone knows this. The question is do the benefits outweigh the risks? A highly personal decision, but one that should be made knowing ALL of the details of our health. Including but not only CV.
In addition to lipid panel and heart scan, fasting glucose, hemoglobin A1C, Dexa scan for bone density, blood pressure (metabolic syndrome in general) and of course overall health. Obese? Habitually sedentary? Any adverse features among these may make ADT more dangerous than is practical.
And yet it does an important job, for which there is yet no substitute for.
I feel bad for guys who decline ADT outright because of what they’ve heard about it. The dreaded side effects make their way to the top of the folklore because those who suffer the most make the loudest complaints. The side effects are real, but can be eliminated or lessened in a number of ways.
The reality is it can be the difference maker, and quite worth it for many of us.
The risk for CVD is increased. Therefore I always argue that we need to complement ADT by exercise and diet to mitigate this risk. Switch to a WFPBD, go running/cycling/walking daily, lift weights and do gymnastics. Stop drinking alcohol and avoid sugar, oil and processed food. Lower your stress level as much as you can and start meditating. I also follow time restricted eating (18:6 or 16:8) and my BMI is under 20. I trust that this „package“ provides sufficient support to fight the side effects including CVD. I do a DEXA scan once a year and will do artery CT in autumn. And yes, I have a lot of fun in my life, enjoy it a lot and hope to survive another 20 years minimum. 😉
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