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.
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.
What Increases Your Risk?
Unhealthy habits can make it more likely for you to have harmful effects from androgen deprivation therapy, for example:
- Poor diet (including too much salt, saturated fat, cholesterol, and sugar)
- Lack of exercise
- Smoking
Also, if you have high blood pressure, high cholesterol, or diabetes, not treating those conditions could increase your risk for cardiovascular problems from ADT.
If you have known heart problems, such as coronary artery disease, plaque and blockage of heart arteries, or if you have had a heart attack, you may have a higher risk of a cardiac event in the first year undergoing ADT. Also, in some cases certain types of ADT may be better for your heart, so it is very important to talk with your cancer doctor (oncologist) about your heart health before starting ADT.
When to Call a Doctor
It is important to talk to your doctor if you are experiencing symptoms such as:
- Chest pain or discomfort
- Shortness of breath at rest or with activity
- Fatigue or tiredness limiting your ability to exercise
- Dizziness or lightheadedness
- Passing out
- Swelling in the legs
- Pain or cramping of the legs at rest or with walking
You should seek emergency medical care for severe symptoms.
If you notice signs of stroke—someone having sudden loss of movement in face, leg or arm, or trouble speaking—call 911 at once. It’s important to act fast to avoid permanent brain damage or even death.
Exams and Tests
To help minimize harm from androgen deprivation therapy, your physician will conduct a thorough history and physical exam to assess your heart risk factors or evaluate any existing cardiovascular disease you may have.
Talk about the risks and benefits of the treatment with your doctor. It’s also good to go over the plan for future treatment and follow-up visits.
Tests to evaluate your risk may include blood tests such as:
- Fasting cholesterol (lipid panel)
- Fasting blood sugar
- Kidney function and blood electrolytes (potassium, sodium, calcium)
- Complete blood count, including hemoglobin, to assess for anemia
- Brain natriuretic peptide, a test evaluating for signs of heart failure
Other tests include:
- Electrocardiogram, ECG, a test to evaluate electrical activity of the heart
- Echocardiography, an ultrasound examination of the heart to assess size, thickness of the muscle, pumping function and relaxation of the heart, and valve function
- Stress testing, exercise testing while monitoring of the heart to look for signs that might suggest blocked coronary arteries.
Preventing Heart Problems
If you have prostate cancer and are receiving androgen deprivation therapy, the best way to prevent developing heart problems is to control your risk factors and manage existing heart disease.
Regular exercise, attention to a healthy diet, and a healthy body weight are important for everyone—especially if you are being treated with ADT.
Eat Better
Try to follow a diet rich in fruits, vegetables, and whole grains, while limiting saturated fats and refined sugars. Weight gain and increased body fat often accompany ADT, so limiting the calories you consume through portion control is important. You may find it helpful to talk to a dietitian to learn about healthy ways to eat.
Stop Smoking
Avoid tobacco in any form (for example, smoking or chewing) and nicotine in e-cigarettes. Tobacco use is a leading cause of heart disease. Prostate cancer patients who use tobacco have a higher rate of death than prostate cancer patients who do not use tobacco.
Exercise
After talking to your health care professional, you should start or continue to exercise regularly with a goal of building up to at least 150 minutes of moderate-intensity activity every week. Examples of moderate-intensity activity include walking briskly, swimming, water aerobics, and tennis.
Because of the potential for increased body fat and reduced muscle mass, you should also engage in two sessions of strength training every week. Examples of strength training include light weightlifting, use of resistance bands, pushups, yoga and Pilates.
Control Other Conditions
Control high blood pressure by eating a low-salt (sodium) diet, exercising, and taking medicine if needed. If you need medicine to lower your blood pressure, angiotensin converting enzyme inhibitors and angiotensin receptor blockers (ACEI and ARBs) may be good options because some research suggests they offer better outcomes for patients with cancer, including those with prostate cancer.
Manage your cholesterol, including total-, LDL- (bad), HDL- (good) cholesterol, and triglycerides by adopting healthy habits: healthy diet, regular exercise, and weight control. If cholesterol levels are abnormal and do not improve despite lifestyle changes, you may have to start medication. Statin drugs are the most commonly used and proven agents.
If you have diabetes, it’s very important to keep the condition under control and treat it aggressively, according to the American Diabetes Association guidelines. Androgen deprivation therapy can be associated with high blood sugars. As exercise and weight loss help control blood sugars, it is essential to follow a healthy diet and get regular exercise when undergoing ADT.
What About Aspirin?
In general, aspirin may be beneficial in some men as a preventive measure of cardiovascular disease, although more research is needed to better identify which men would benefit from its use.
If you already have cardiovascular disease, continue your treatment and practice healthy habits. This may include aspirin, medicine to lower cholesterol or blood pressure, or both.
Talk to your health care professional if you have any questions. Also, never start or stop taking medicine without talking to your care team.
Living With Your Condition
With any complex medical problem, good communication and a strong partnership between you and your health care team will improve your chances of having the best possible outcome.
Be proactive and talk about your heart health and what matters to you with your care team.
Although androgen deprivation therapy carries some cardiovascular risk, it can be very effective in treating prostate cancer. Being aware of your heart health and adopting healthy habits can help you minimize your cardiovascular risk during cancer treatment.