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Weighing the risks: prostate cancer versus cardiovascular disease.

The treatment of prostate cancer can be a very case-specific decision. Although it is clear that surgery provides a cure for some patients, there can be negative side effects that would make it the wrong therapeutic option for others. Some patients who are older and have low-volume prostate cancer may be excellent candidates for the expectant management of prostate cancer, whereas this would certainly be the wrong choice for a younger, healthier man who could tolerate the side effects of active treatment. Radiotherapy also has proven efficacy for the treatment of prostate cancer. Although the addition of androgen deprivation therapy (ADT) to surgery has not demonstrated any therapeutic benefit, there is a sizable literature describing the improved prostate cancer-specific survival enjoyed by patients treated with a combination of ADT and radiotherapy. Recently a group from Brigham and Women’s Hospital in Boston has published several very important articles that add a caveat to the widely accepted notion that the addition of ADT in the treatment of prostate cancer is beneficial and benign. The first of these studies examined whether men with localized prostate cancer treated with ADT had an increased risk of cardiovascular-related mortality.