Cardio-Oncology: Prostate Cancer Treatment and Your Heart

If you have prostate cancer, hormone therapy may be part of your treatment. Stopping some hormones can prevent the growth of cancer cells. Androgen deprivation therapy (ADT) includes surgery or medicines that aim to block the effects of male hormones such as testosterone—called androgens—that can cause cancer cells to grow and spread.  

This therapy can make developing cardiovascular disease (heart and blood vessel problems) more likely. It also can make existing heart disease worse.

Use this resource to learn how hormone therapy can affect your heart, how to prevent heart disease, and questions to ask your doctor. 

Possible Heart Effects

How does androgen deprivation therapy, or ADT, affect your heart?

Research has not shown that androgen deprivation therapy definitively causes cardiovascular disease. However, we do know that men who receive hormone therapy have a higher likelihood of developing conditions that increase their chance of cardiovascular disease.

For example, ADT has been shown to:

·         Raise cholesterol levels

·         Raise blood sugar levels

·         Reduce the body’s ability to process sugar

·         Increase body fat

·         Reduce muscle mass

·         Increase the thickness of the walls of blood vessels

Having higher levels of blood sugar and difficulty processing blood sugar can cause diabetes. If you have diabetes, you are more likely to develop heart disease or have a stroke. 

In men with prostate cancer who already have a buildup of plaque—made up of cholesterol, fatty substances and calcium—in their arteries (atherosclerosis), ADT might increase the chance that patients may suffer from a heart attack.

ADT also can make you have low counts of red blood cells, a condition called anemia, which may stress your heart. If you have anemia, less oxygen goes to your heart muscle. 

Reducing testosterone to very low levels also may increase the chance of blood clots forming in your blood vessels, known as deep venous thrombosis.

Symptoms of Heart Disease

·         Cardiovascular disease can cause many different symptoms including: 

·         Chest pain (including pressure, tightness, heaviness)

·         Shortness of breath

·         Tiredness

·         Dizziness or lightheadedness

·         Passing out

·         Swelling in the legs

·         Pain or cramping of the legs with walking

Cardiovascular disease can also result in a stroke or mini-stroke (also called transient ischemic attack). Symptoms include: trouble speaking, loss of vision, weakness or inability to move part of the body, or abnormal feeling (sensation) in part of the body.

Treatment With ADT

Although the link between ADT and cardiovascular disease has not been proved, if you are on ADT, it’s important to take steps to protect your heart. Adopt healthy habits and try to control conditions that are major risk factors for developing cardiovascular disease:

·         Blood pressure

·         Cholesterol

·         Diabetes

·         Weight

·         Tobacco use

·         Physical inactivity

If you already have cardiovascular disease and need androgen deprivation therapy, it is important to continue your treatment and, if needed, take medicines proven to help lower the chances the disease gets worse.