TUESDAY, Oct. 9 (HealthDay News) -- Prostate cancer patients receiving androgen-deprivation therapy, a common form of hormone treatment proven to slow tumor growth and prolong life, may face a nearly threefold higher risk of dying from heart disease, a new study suggests.

The apparent danger results from a drop in testosterone levels that is central to androgen-deprivation therapy's (ADT) effectiveness at curbing prostate cancer, the study authors said.

This drop in testosterone can provoke insulin resistance, leading to type 2 diabetes, as well as a gain in body mass, body fat and so-called bad cholesterol. Collectively, this group of problems is called the "metabolic syndrome," a condition long-associated with cardiac complications.

"However, I think overall ADT does help people with prostate cancer, and until it's studied further this can't be considered proof that there's a connection between the cardiac effects and hormone therapy," said study author Dr. Henry K. Tsai, who throughout the study period served as a resident in training in the Harvard Radiation Oncology Program in Boston.

"But patients need to think about being evaluated carefully by their doctor to see whether they're appropriate candidates for hormone therapy and be informed about the potential risks," Tsai added.

This new finding, published in the Oct. 17 issue of the Journal of the National Cancer Institute, follows research released in 2005 that highlighted ADT's link to an increased risk for bone fractures and osteoporosis.

The new findings are based on an analysis of medical records and questionnaires completed by nearly 4,900 patients between the ages of 39 and 86 who had been diagnosed with localized prostate cancer between 1995 and 2004.

All the patients had participated in a larger nationwide prostate cancer research project involving more than 13,000 men, during which all had indicated whether they had any preexisting medical complications in addition to cancer.

Of the 4,900 patients, nearly 3,300 had undergone prostate removal surgery following diagnosis.

The remainder underwent nonsurgical treatments, such as external beam radiation therapy; brachytherapy (involving the insertion of small radioactive pellets directly into the prostate); and/or cryotherapy (involving the freezing of tumor cells).

In addition, 266 of those patients who underwent surgery and 749 of those receiving an alternate treatment also received androgen-deprivation therapy.

The patients were tracked for an average of about four years following the start of all treatments; the patients receiving ADT did so for an average of about four months.

Tsai and his colleagues found that patients over the age of 65 who had undergone both prostate removal surgery and ADT had a 5.5 percent increased risk of dying from a cardiac event within five years of starting the hormone treatment. This compared to a 2 percent greater risk among patients older than 65 who had surgery alone.

The "relative risk" jump was similar among younger patients. Those under 65 who had surgery and hormone therapy had a 3.6 percent greater risk of death from heart disease within five years, compared with a 1.2 percent risk among those undergoing surgery alone.

ADT was not associated with any increased cardiac risk among patients undergoing any of the nonsurgical treatments.

An editorial accompanying the study calls for more research into the topic.

Jerome Seidenfeld and his colleagues at the University of Connecticut Health Center suggest that while Tsai's analysis of previously collected data raises an "interesting hypothesis," no definitive link to cancer risk can be proved until a clinical trial of prostate cancer patients currently undergoing hormone treatment is launched.

Tsai agreed.

"I pretty much feel similarly," Tsai said. "The editorial emphasizes that this is a preliminary study, and clinical trials are the gold standard. And we need one to confirm our findings."

Tsai, currently working as a radiation oncologist with Radiation Oncology Consultants in Princeton, N.J., said he doesn't want prostate cancer patients to view androgen-deprivation therapy with alarm.

"I don't think patients should be afraid," he said. "This is just what I'd call emerging data, and while the relative increase in risk for heart disease is large, in absolute terms the risk is still very small."

Dr. Nelson Neal Stone, a clinical professor of urology and radiation oncology at Mount Sinai School of Medicine in New York City, said the exact mechanism by which ADT might boost the risk for cardiac complications remains undefined, despite a widespread appreciation for the array of problems that accompany the metabolic syndrome.

In that light, he suggested that physicians should target the onset of the life-threatening syndrome as well as the life-prolonging treatment.

"The message is that we need to start paying attention to our patients' general health when we put them on hormonal therapy," he said. "And perhaps we should be putting them on a diet to control for the potential side effects of the therapy, and the serious impact it can have on their health."

"We can't take away the hormones altogether because there's a major benefit to that treatment," Stone added. "But we need to develop a good strategy for dealing with the negative consequences that occur."

More information

To learn more about prostate cancer and its treatment, visit the American Cancer Society  .

FRIDAY, Oct. 5 (HealthDay News) -- Few men may realize it, but if they're having problems achieving or sustaining erections, it may signal underlying heart trouble.

Erectile dysfunction, or impotence, affects more than 18 million American men, according to a recent study by researchers at the Johns Hopkins Bloomberg School of Public Health.

And now a growing body of research ties erectile dysfunction to vascular diseases, such as coronary artery disease.

"Erectile dysfunction is often caused by vascular disease," explained Dr. Ian Thompson, professor and chairman of the department of urology at the University of Texas Health Science Center at San Antonio. "A man could perceive decreased blood flow to the penis as being a less strong, a weaker erection, and that may actually be one of the first indicators of blood vessel disease."

One recent report found men with erectile dysfunction had poorer scores on exercise tests and other measures of coronary heart disease. They also had evidence of significant coronary artery blockages.

"Our study found that among men who were sent for a stress test by their doctor, the presence of erectile dysfunction was a potent predictor -- a strong risk factor -- for significant underlying heart disease," said lead researcher Dr. R. Parker Ward, an assistant professor of medicine and director of the cardiology clinic at the University of Chicago Hospitals.

"It was a stronger risk factor than some of the traditional risk factors we commonly ask questions about, things like high blood pressure and high cholesterol," he added.

Ward's study, published last year in the Archives of Internal Medicine, involved men who had been referred to cardiologists for nuclear stress testing, a noninvasive way to determine the severity of coronary heart disease. But even among men without heart symptoms, erectile dysfunction is a strong risk factor for future risk of heart attack, he noted.

In the same issue of the journal, Dr. Steven A. Grover and colleagues studied a group of 3,912 Canadian men, nearly half of whom reported having erectile dysfunction in the four weeks prior to visiting their family physicians. The men's cholesterol, glucose and blood pressure measurements were taken.

"When you calculated a global cardiovascular risk, [it] was strongly associated with the probability that you had erectile dysfunction," said Grover, a professor of medicine and epidemiology at McGill University Health Centre in Montreal. "And subsequently there have been other studies that have shown that people who have erectile dysfunction are, in fact, more likely to develop cardiovascular disease in the future."

Thompson and his colleagues provided the first substantial evidence linking erectile dysfunction and subsequent risk for heart disease in a December 2005 report in the Journal of the American Medical Association. Yet the connection is not as well recognized among doctors and patients as cardiologists and urologists think it should be.

"A lot of men don't have physicians," Thompson explained. "They may not know what their blood pressure is or their lipid profiles, or they may be smokers, and they may never have been counseled to stop smoking or to reduce their weight.

"We think that if men with erectile dysfunction went to see their physicians, it may enable the interaction with the physician to discuss other coronary risk factors," he said.

Erectile problems aren't always vascular in nature. Sometimes the trouble is psychological or neurological and wouldn't necessarily be associated with a higher risk of heart disease, Ward cautioned. Still, research linking erectile dysfunction (ED) and heart disease suggests that a proactive approach is the best medicine.

"We as physicians should be asking about, and men should be reporting to their physicians, symptoms of ED, so it can be considered as we work to modify their risk -- treat blood pressure, cholesterol more aggressively, advise healthy lifestyle changes like exercise and healthy diet," he said.

More information

Visit the U.S. National Heart, Lung, and Blood Institute for more on coronary artery disease.

TUESDAY, Sept. 25 (HealthDay News) -- In the United States, preventive health exams account for about 1 in 12 adult outpatient visits to doctors, says a study that found that, each year between 2002 and 2004, about 63.5 million adults had a preventive health or gynecological check-up, at an annual cost of $7.8 billion.

Researchers from the University of Pittsburgh School of Medicine and RAND Health, Pittsburgh, analyzed 2002-2004 data from a nationally representative survey of office-based doctors.

During those three years, the doctors in the survey had 181,173 adult outpatient visits. Of those, 5,387 were preventive health exams and 3,026 were preventive gynecological exams.

Translated nationwide, those figures were equivalent to 44.4 million adults (20.9 percent of the population) having preventive health exams and 19.4 million women (17.7 percent of adult women) having preventive gynecological exams each year, the researchers said.

Adults in the Northeast were 60 percent more likely to have a preventive health exam than those in the West, and uninsured people were half as likely to have one as those with private insurance or in Medicare.

Mammograms, cholesterol screening, smoking cessation counseling and other preventive services were provided at 52.9 percent of the preventive health exams in the study and in 83.5 percent of preventive gynecological exams.

The findings were published in the Sept. 24 issue of the journal Archives of Internal Medicine.

More information

The American Academy of Family Physicians has more about preventive services for healthy living  .