PETALING JAYA: For some treatments, tackling one disease may come at the risk of aggravating another. An example is prostate cancer, where one of the main treatment options is androgen deprivation therapy (ADT).
Studies have shown that ADT may also increase the patient’s risk of heart, or cardiovascular, disease.
According to consultant urologist Prof Dr Ong Teng Aik, ADT is used to manage cancer that has advanced beyond the prostate.
This can be to the immediate surrounding area (local advancement) or to other organs in the body (metastatic advancement).
He said: “Management for locally-advanced patients is usually radiotherapy to the prostate, with the addition of ADT.
“For metastatic (stage IV) prostate cancer, the mainstay of treatment is ADT, as androgens slow down the growth of prostate cancer cells.
“In addition, a number of extra agents have been shown to prolong the survival of such patients when added to ADT.”
He added: “There are also concerns, however, that ADT poses increased cardiovascular risk.
“Studies have shown possible effects like coronary heart disease, myocardial infarction (heart attack), stroke and sudden cardiac death.”
This is especially so for those who already have heart diseases or risk factors for the condition.
According to Prof Ong, around one in three prostate cancer patients have pre-existing heart disease.
This is not surprising, he said, as both heart disease and prostate cancer are associated with older age.
Fortunately, he noted that not all forms of ADT seem to come with this increased risk.
As indicated by its name, ADT aims to deprive prostate cancer cells of the androgens, or male sex hormones, that power their growth.
The different forms of ADT fall into one of three categories: they reduce androgen production by the testicles, block the action of androgens in the body, or block androgen production in the body.
Gonadotropin-releasing hormone (GnRH) antagonists and agonists, also known as luteinising hormone-releasing hormone (LHRH) antagonists and agonists respectively, are two types of drugs under the first category.
Research involving these two drugs found that prostate cancer patients on GnRH antagonists had a significantly lower risk of cardiac events, compared to those on GnRH agonists.
Prof Ong stressed that at the end of the day, the potential benefits of ADT in fighting prostate cancer appear to outweigh any other disease risks.
“The best course of action is for patients to consult their doctors, who will be able to map out the most suitable treatment options.
“Getting the right treatment is crucial for prostate cancer patients as only a doctor will be able to provide maximum cancer control and safe treatment options aimed at minimising the impact on one’s life.
“While it is a very personal journey for every patient to embark on, it is crucial that a strong support system is in place.
“Support from loved ones is crucial, along with spiritual and medical support,” he added.
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