Edelman Scott, Butler Javed, Hershatter Bruce W, Khan Mohammad K
Department of Radiation Oncology, Emory University, Atlanta, GA; Winship Cancer Institute, Emory University, Atlanta, GA.
Division of Cardiology, Emory University, Atlanta, GA.
Clin Genitourin Cancer. 2014 Dec;12(6):399-407. doi: 10.1016/j.clgc.2014.07.009. Epub 2014 Aug 2.
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.
本文回顾了关于雄激素剥夺疗法（ADT）与前列腺癌男性心力衰竭之间可能关联的相互矛盾的临床证据，其中包括2个基于人群的登记研究显示存在这种关联，以及1个显示无关联的研究。对雄激素在分子水平上对心肌细胞收缩性的影响、睾酮对心血管系统（特别是心脏功能）的影响，以及睾酮疗法对心力衰竭患者的有益作用的研究，可能有助于阐明这一争议。未来需要开展研究来评估ADT对心力衰竭终点的影响。在讨论临床前和临床文献对有心力衰竭风险的男性前列腺癌管理的影响时，作者根据已发表的随机试验，权衡了ADT对心脏功能和心力衰竭的可能不良影响与其对癌症结局的已知益处。在缺乏ADT导致心力衰竭的确凿证据的情况下，作者讨论了为降低心力衰竭风险同时又不影响前列腺癌结局，ADT可能被延迟、短期或间歇给药或不进行治疗的临床情况。
