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Hormone therapy and heart problems

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User
Posted 14 May 2021 at 22:46

Hi I’ve been on hormone therapy for 12 months following Radiotherapy.  Other than some minor discomfort from hot flashes and some weight gain I’ve not experienced any major discomfort.

Today I had an angiogram test and discovered I had developed Atrial Fibrillation which was unexpected.

I note that some research is showing a causal link between anti androgen drugs and QT prolongation. This serious medical condition is a disruption of the heart rhythm and can be fatal.  Not wishing to cause panic I’m interested to hear if anyone else is aware of this. If the research is valid should patients on this treatment be warned of this side effect?

User
Posted 15 May 2021 at 00:39
AF and other heart problems are a known risk with the various hormone treatments; there will be information on your patient leaflet and there is plenty of info on the Cancer Research UK website. PCUK website states that anyone with pre-exusting cardiovascular issues should discuss this with their doctors before starting HT. It is one of the very good reasons for having regular check ups with the GP while on HT.

Docetaxel and other chemo can also cause heart damage; the fact is, many treatments for serious health conditions have the potential to cause new problems. Like any treatment then, it is about balancing risk.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 14 May 2021 at 23:39
Hi LKV,

Sorry to hear that and very interesting as I too have been diagnosed with AFib. Initially I thought the cause was from the HT treatment. However, I then back tracked on my regular blood pressure/ pulse readings that I had recorded over the years, and found that it coincided with the actual PC diagnosis some 4 months prior to starting the HT. I identified an increase in my resting pulse rate on various days (i.e. from 60bpm to 80 bpm) which is a symptom.

In reading literature, I found that a major stressful event can trigger AFib, as well as ageing ( I was 68 at the time). Getting the PC diagnosis really got to me. I also got a case of IBS at the time from the stress. Of course its possible that the HT was the trigger of the AFib for you, but it could be just coincidence? I do however feel on reflection that maybe it would have been beneficial to have had an ECG prior to starting HT.

I then had to embark on another journey to improve knowledge of AFib and reading forums to identify issues etc, and found it's far more complex than PC. You are partially correct that it can be fatal, especially as stroke risk goes up five fold. (I ended up having a stroke 4 months ago but made a quick recovery). The issue isn't always the AFib, it's the "company that it keeps" more often being the culprit i.e. diabetes etc. I highly recommend the Health Unlocked forum for AF, as there's much to learn...!

User
Posted 15 May 2021 at 18:33

This appears to be the definitive paper on the subject:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4516188/

Its conclusions are:

"It is clear that overall, the use of ADT in the treatment of prostate cancer is associated with an increased risk of cardiovascular complications. However, for the most part the excess risk is modest though significant, and must be weighed against the equally clear benefits of ADT in appropriate patients. In the future, better identification of patients at risk – particularly those with a previous history of myocardial infarction or CHF – and perhaps more tailoring of the form and duration of ADT in an individual patient, might ameliorate the risk. However, awareness and management of the risks of cardiovascular complications must not result in the under-use of ADT, which for all its shortcomings is still a supremely important modality nearly 74 years after Charles Huggins’ original publication."

Edited by member 15 May 2021 at 18:34  | Reason: Not specified

User
Posted 16 May 2021 at 01:11

Hi,

Not wishing to worry anyone but I was diagnosed in June 2014, was started on Zoladex HT on July 1st and had four weeks radiotherapy in mid October / early November.  Two weeks after I finished radiotherapy, I had a heart attack.

It did turn out that I had a heart condition that had never been discovered.  My cardiologist said that he wasn't sure if the hormone treatment had played a part in me having a heart attack at that time but agreed that it was a possibility.  A higher risk of Cardiac problems is a possible side effect of hormone treatment. 

I have been on hormone treatment again for three years since I had reoccurance of my cancer and so far, I've had no further heart problems. 

Steve 

 

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User
Posted 14 May 2021 at 23:16
Define QT prolongation Spock lol. It is quite well known I thought that injectable HT starts off a multitude of health issues including heart problems. And Enzalutamide initiates at least 3 coronary malfunctions also. It’s good to do research of your own. Some people say not to Dr Google , but my Onco is relieved we have challenged him and taken informed choices. It is their job to offer anything at all in the hope of extending life , but it’s not always the right thing for that person.
User
Posted 14 May 2021 at 23:37

QT prolongation is a measure of delayed ventricular repolarisation, which means the heart muscle takes longer than normal to recharge between beats. It is an electrical disturbance which can be seen on an electrocardiogram (ECG). Excessive QT prolongation can trigger tachycardias such as torsades de pointes (TdP).

Not sure what all that means but I guess it’s to do with an interference with heart rhythm.  
When it’s my life I reserve the right to undertake my own research into risk factors.  I’m not convinced that research findings are passed on to patients.  Too much reliance on pharmaceutical interests. Surely if my research is valid this has serious implications for all patients on hormone therapy?

 

User
Posted 14 May 2021 at 23:39
Hi LKV,

Sorry to hear that and very interesting as I too have been diagnosed with AFib. Initially I thought the cause was from the HT treatment. However, I then back tracked on my regular blood pressure/ pulse readings that I had recorded over the years, and found that it coincided with the actual PC diagnosis some 4 months prior to starting the HT. I identified an increase in my resting pulse rate on various days (i.e. from 60bpm to 80 bpm) which is a symptom.

In reading literature, I found that a major stressful event can trigger AFib, as well as ageing ( I was 68 at the time). Getting the PC diagnosis really got to me. I also got a case of IBS at the time from the stress. Of course its possible that the HT was the trigger of the AFib for you, but it could be just coincidence? I do however feel on reflection that maybe it would have been beneficial to have had an ECG prior to starting HT.

I then had to embark on another journey to improve knowledge of AFib and reading forums to identify issues etc, and found it's far more complex than PC. You are partially correct that it can be fatal, especially as stroke risk goes up five fold. (I ended up having a stroke 4 months ago but made a quick recovery). The issue isn't always the AFib, it's the "company that it keeps" more often being the culprit i.e. diabetes etc. I highly recommend the Health Unlocked forum for AF, as there's much to learn...!

User
Posted 14 May 2021 at 23:49

If there are cardiac risks associated with ht then why is it not stated in the treatment leaflets as a side effect?

Is Prostrate Cancer Uk aware of these risks ?

User
Posted 15 May 2021 at 00:39
AF and other heart problems are a known risk with the various hormone treatments; there will be information on your patient leaflet and there is plenty of info on the Cancer Research UK website. PCUK website states that anyone with pre-exusting cardiovascular issues should discuss this with their doctors before starting HT. It is one of the very good reasons for having regular check ups with the GP while on HT.

Docetaxel and other chemo can also cause heart damage; the fact is, many treatments for serious health conditions have the potential to cause new problems. Like any treatment then, it is about balancing risk.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 15 May 2021 at 08:29

I’ve clearly missed this warning.

GPs seem to wash their hands of patients under treatment by hospital specialists. Mine has just stopped taking blood samples for PSA monitoring. As this side effect has such serious implications I agree that regular monitoring should be part of the treatment plan.  Why isn’t more emphasis placed in this risk ?  Due to the comparatively slow development of PC perhaps the cure is more risky than the disease itself if longevity is the aim ?

User
Posted 15 May 2021 at 09:49
Rather like the Astrazeneca vaccine and the blood clot scenario in as much it will benefit the majority but a small number may be seriously affected. The major difference being that the vaccine will also indirectly benefit others regardless but HT benefit or adversely affect the individual. Brings home the advisability of checking known problems with medications that you may be susceptible to.
Barry
User
Posted 15 May 2021 at 11:35

Thanks Barry for your comments however I’m not sure how small is ‘small’ in the numbers affected ?  I’m still searching the leaflets I received but yet to find this as a side effect. 
I know it’s a personal decision to balance potential for developing a heart condition against defeating PC.  The clinicians aim is to defeat PC although as we know the debate against routine screening is around receiving unnecessary treatment for something that is unlikely to kill you due to its slow development. If the treatment can cause heart disease, stroke, impotence and premature death that’s an argument against screening?

les

User
Posted 15 May 2021 at 17:03
It's known that there are major and minor risks with having PCa treatment and that includes for example the risk of dying during surgery or short/long term damage with RT and the possibility of severe side effects. It's also known that a considerable number of men lay themselves open to this risk when had they not had treatment they would have died from something else eventually. This is the main reason given why screening is not offered automatically, because most men with a PCa diagnosis would want and expect to have treatment even for early PCa (which almost all men will develop if they live long enough). Where PCa is diagnosed early, there is an argument for just actively monitoring it or for treating with HIFU for suitable men, which is a milder treatment, and also has less side effects than surgery or radiation. Should it become necessary, this can be followed by more radical treatment.

All these things and more should be taken into consideration but I am sure most men just rely on a gut feeling before taking the treatment plunge. This is evident because some really want their consultant to decide for them without considering all the possible consequences. Of course, as lay people we have to rely on the expertise of consultants but as with making any major decision a man is in a better position to do so if he is pretty well informed.

Barry
User
Posted 15 May 2021 at 18:33

This appears to be the definitive paper on the subject:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4516188/

Its conclusions are:

"It is clear that overall, the use of ADT in the treatment of prostate cancer is associated with an increased risk of cardiovascular complications. However, for the most part the excess risk is modest though significant, and must be weighed against the equally clear benefits of ADT in appropriate patients. In the future, better identification of patients at risk – particularly those with a previous history of myocardial infarction or CHF – and perhaps more tailoring of the form and duration of ADT in an individual patient, might ameliorate the risk. However, awareness and management of the risks of cardiovascular complications must not result in the under-use of ADT, which for all its shortcomings is still a supremely important modality nearly 74 years after Charles Huggins’ original publication."

Edited by member 15 May 2021 at 18:34  | Reason: Not specified

User
Posted 15 May 2021 at 18:44

As others have said, HT (or rather, low/no testosterone) is known to cause many issues in the body. The duration for which it's taken is about balancing those increasing risks with the benefits of a higher chance of cure, where the incremental benefit reduces with time.

Some risks are:
Osteoporosis, diabetes, metabolic syndrome, high cholesterol, raised blood pressure, cardio vascular disease, gynecomastia, damage to penile structures, ...

For those on lifelong HT where such a trade-off can't be used, the HT does cause the death of some of the patients, rather than the PCa, but without it, their life would have been shorter still.

Some patients with a particularly high risk of cardio vascular events are given Degarelix instead of the other HT drugs, because it is claimed to have a slightly lower impact on cardio vascular events.

No treatments are without risk, but considerable thought is given to balancing the risks and benefits of all the treatments.

User
Posted 16 May 2021 at 01:11

Hi,

Not wishing to worry anyone but I was diagnosed in June 2014, was started on Zoladex HT on July 1st and had four weeks radiotherapy in mid October / early November.  Two weeks after I finished radiotherapy, I had a heart attack.

It did turn out that I had a heart condition that had never been discovered.  My cardiologist said that he wasn't sure if the hormone treatment had played a part in me having a heart attack at that time but agreed that it was a possibility.  A higher risk of Cardiac problems is a possible side effect of hormone treatment. 

I have been on hormone treatment again for three years since I had reoccurance of my cancer and so far, I've had no further heart problems. 

Steve 

 

User
Posted 16 May 2021 at 09:20

I guess the question can only be answered by looking into the future.  What is more likely to shorten your life - a cardiac event or PCa ?  Given the usually slow nature of PCa and the rapid onset of death from heart disease and stroke doesn’t age have a part to play in the equation?

Would you ask an Oncologist or a Cardiologist for the odds of 5 years survival rate for an 80 years old with PCa in remission and AF continuing to take HT?

 

User
Posted 21 Feb 2024 at 13:06

Diagnosed PCa April 2022. On Zoladex since then prescribed until May 2025 (3 years). Successful radiotherapy November 2022. PSA <0.1 since then. November 2023 diagnosed with atrial fibrillation, left ventricular problems and aortic stenosis. Possible causal relationship - unprovable. Consultant oncologist says he is 'happy' for me to cease Zoladex after 2 years (i.e. May 2024). Is this sensible? Any info on enhanced risk of PCa recurrence if stop after 2 rather than 3 years?

 
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