title: The effects of androgen deprivation therapy on cardiac function and heart failure: implications for management of prostate cancer.
abstract: Conflicting clinical evidence regarding the possible association between androgen deprivation therapy (ADT) with heart failure in men with prostate cancer is reviewed, including 2 population-based registries showing such an association, and 1 showing no association. Studies of the effects of androgens on cardiomyocyte contractility at the molecular level, the effects of testosterone on the cardiovascular system, particularly cardiac function, and the beneficial effects of testosterone therapy for patients with heart failure might help illuminate this controversy. Future studies are needed to evaluate the effect of ADT on end points of heart failure. The authors weigh the possible adverse effects of ADT on cardiac function and heart failure against its known benefits to cancer outcomes, defined according to published, randomized trials, in a discussion of the implications of the preclinical and clinical literature on the management of prostate cancer in men at risk for heart failure. In the absence of conclusive evidence that ADT causes heart failure, the authors discuss clinical situations in which ADT may be delayed, given on a short-term or intermittent basis, or withheld from treatment with the goal of reducing the risks of heart failure without compromising prostate cancer outcomes.
authors.affiliation: Department of Radiation Oncology, Emory University, Atlanta, GA; Winship Cancer Institute, Emory University, Atlanta, GA. Electronic address: sedelm2@emory.edu.
authors.forename: Scott
authors.initials: S
authors.lastname: Edelman
authors.affiliation: Division of Cardiology, Emory University, Atlanta, GA.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.affiliation: Department of Radiation Oncology, Emory University, Atlanta, GA; Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Hershatter
authors.affiliation: Department of Radiation Oncology, Emory University, Atlanta, GA; Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Mohammad K
authors.initials: MK
authors.lastname: Khan
mesh_terms: D000726:Androgen Antagonists / Q000009:adverse effects*; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects*; D006321:Heart / Q000187:drug effects*; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000188:drug therapy*
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal
keywords: Antiandrogen; Cardiovascular system; Gonadotropin hormone-releasing hormone agonist; Prostate adenocarcinoma; Testosterone