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Hormone reduction for prostate cancer may harm kidneys

Los Angeles Times


July 16--As the use of hormone reduction therapy becomes increasingly common in the treatment of prostate cancer, a new study has linked the practice to an increased risk of acute kidney injury.

In a study published Tuesday in the Journal of the American Medical Assn., researchers examined the medical records of more than 10,000 men with nonmetastatic prostate cancer and found that use of androgen deprivation therapy, or ADT, was associated with a 2.5 times greater risk of acute kidney injury.

"Androgen deprivation therapy is the mainstay treatment for patients with advanced prostate cancer," wrote lead study author Francesco Lapi, a researcher at Jewish General Hospital in Montreal, and colleagues.

"While this therapy has been traditionally reserved for patients with advanced disease, ADT is increasingly being used in patients with less severe forms of the cancer.... Although ADT has been shown to have beneficial effects on prostate cancer progression, serious adverse events can occur during treatment."

Androgens are male hormones. By reducing their concentration in the body, doctors hope to prevent them from encouraging the growth of prostate cancer cells.

The problem with reducing these hormones -- testosterone in particular -- is that they appear to protect kidneys by improving blood flow, according to study authors. Removing them may cause damage to the tiny capillaries that filter waste from the bloodstream and trigger acute kidney injury. (Acute kidney injury is fatal in roughly half of all cases.)

Researchers conducted their study by pulling comprehensive health records from the United Kingdom Clinical Practice Research Datalink and the Hospital Episodes Statistics database. The anonymous records contained information on patient body mass index and alcohol and tobacco use, so that these factors could also be accounted for, authors wrote.

A total of 10,250 patients were included in the study. Of those, researchers identified 232 cases of acute kidney injury. Compared with patients who never underwent hormone reduction therapy, ADT patients stood a 2.5 times greater risk of acute kidney injury.

"To our knowledge, this is the first population-based study to investigate the association between the use of ADT and the risk of acute kidney injury in men with prostate cancer," the authors wrote.

Physicians use a variety of methods to reduce male hormones in prostate cancer patients. The methods include surgical castration, drugs that lower the amount of testosterone produced by the testes and medications that block the body's ability to use androgens.

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