【科普】前列腺癌术后，如何保护好心脏
发布于 2010-06-21 · 浏览 1862 · IP 广东广东
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Ask the doctor: What can I do to protect my heart if my body no longer makes testosterone?
Q. A year ago, I had an orchiectomy for prostate cancer; my PSA is now 0.74. Not long afterward, I had two cardiac stents implanted. I still have some angina and shortness of breath. I started Ranexa a couple of weeks ago, which helps my angina. Do you have any suggestions for my heart since I no longer make testosterone, which I understand helps protect men's hearts and arteries?
A. In men with prostate cancer, testosterone plays opposing roles. On the negative side of the ledger, it fuels the growth of prostate cancer cells, helping them grow, divide, and sometimes spread throughout the body. For this reason, various methods are used to stop the body from making testosterone or to block cells from responding to it. Removing a man's testicles (orchiectomy) is an effective way to shut off production of this hormone without the need for daily medications. Orchiectomy has been used for years to slow or stop the growth and spread of prostate cancer.
On the positive side of the ledger, testosterone helps maintain muscle mass and healthy cardiac function. In men, low levels of testosterone have been linked to an increased risk for developing type 2 diabetes and cardiovascular disease. And several studies suggest that shutting down or blocking testosterone in men with prostate cancer may increase their risk of developing heart disease.
More and more, doctors are prescribing testosterone replacement therapy for relatively healthy men with low testosterone levels (under 300 nanograms per deciliter of blood). But there is no consensus on whether this therapy is safe for men who have had prostate cancer. Some clinicians have prescribed testosterone for men with prostate cancer who meet these three conditions: surgery to remove the prostate (prostatectomy), low-grade cancer confined to the prostate, and a virtually undetectable level of prostate-specific antigen (PSA) in the bloodstream. PSA is a protein produced by prostate and prostate cancer cells, and is used to track the effectiveness of treatment and the possible progression of prostate cancer. But we don't know the long-term effects of testosterone replacement therapy in men with this favorable scenario.
Testosterone replacement is even more controversial for men who were treated with radiation therapy instead of surgery, or in someone like you who has had a bilateral orchiectomy and still has a measurable PSA. This could indicate the presence of viable prostate cells that, under the action of testosterone, may be able to transform into cancer.
Whether or not you make or take testosterone, you can follow a checklist to make sure you are doing everything possible to maintain your heart health. Ranolazine (Ranexa) is a new drug for angina, but don't forget about important older ones: aspirin to make your platelets less sticky, clopidogrel (Plavix) to help keep your stents clear, a beta blocker to reduce your heart's demand for oxygen, and a statin to lower your LDL (bad) cholesterol to 70 milligrams per deciliter or below. In addition, exercise daily, follow a diet that is good for your heart and arteries, maintain a healthy body weight, and don't smoke. With these measures, you're stacking the deck in your favor, testosterone or no testosterone.
— Anthony V. D'Amico, M.D., Ph.D.Professor of Radiation OncologyHarvard Medical SchoolBrigham and Women's Hospital
— Samuel Z. Goldhaber, M.D.Professor of MedicineHarvard Medical SchoolBrigham and Women's Hospital
Q. A year ago, I had an orchiectomy for prostate cancer; my PSA is now 0.74. Not long afterward, I had two cardiac stents implanted. I still have some angina and shortness of breath. I started Ranexa a couple of weeks ago, which helps my angina. Do you have any suggestions for my heart since I no longer make testosterone, which I understand helps protect men's hearts and arteries?
A. In men with prostate cancer, testosterone plays opposing roles. On the negative side of the ledger, it fuels the growth of prostate cancer cells, helping them grow, divide, and sometimes spread throughout the body. For this reason, various methods are used to stop the body from making testosterone or to block cells from responding to it. Removing a man's testicles (orchiectomy) is an effective way to shut off production of this hormone without the need for daily medications. Orchiectomy has been used for years to slow or stop the growth and spread of prostate cancer.
On the positive side of the ledger, testosterone helps maintain muscle mass and healthy cardiac function. In men, low levels of testosterone have been linked to an increased risk for developing type 2 diabetes and cardiovascular disease. And several studies suggest that shutting down or blocking testosterone in men with prostate cancer may increase their risk of developing heart disease.
More and more, doctors are prescribing testosterone replacement therapy for relatively healthy men with low testosterone levels (under 300 nanograms per deciliter of blood). But there is no consensus on whether this therapy is safe for men who have had prostate cancer. Some clinicians have prescribed testosterone for men with prostate cancer who meet these three conditions: surgery to remove the prostate (prostatectomy), low-grade cancer confined to the prostate, and a virtually undetectable level of prostate-specific antigen (PSA) in the bloodstream. PSA is a protein produced by prostate and prostate cancer cells, and is used to track the effectiveness of treatment and the possible progression of prostate cancer. But we don't know the long-term effects of testosterone replacement therapy in men with this favorable scenario.
Testosterone replacement is even more controversial for men who were treated with radiation therapy instead of surgery, or in someone like you who has had a bilateral orchiectomy and still has a measurable PSA. This could indicate the presence of viable prostate cells that, under the action of testosterone, may be able to transform into cancer.
Whether or not you make or take testosterone, you can follow a checklist to make sure you are doing everything possible to maintain your heart health. Ranolazine (Ranexa) is a new drug for angina, but don't forget about important older ones: aspirin to make your platelets less sticky, clopidogrel (Plavix) to help keep your stents clear, a beta blocker to reduce your heart's demand for oxygen, and a statin to lower your LDL (bad) cholesterol to 70 milligrams per deciliter or below. In addition, exercise daily, follow a diet that is good for your heart and arteries, maintain a healthy body weight, and don't smoke. With these measures, you're stacking the deck in your favor, testosterone or no testosterone.
— Anthony V. D'Amico, M.D., Ph.D.Professor of Radiation OncologyHarvard Medical SchoolBrigham and Women's Hospital
— Samuel Z. Goldhaber, M.D.Professor of MedicineHarvard Medical SchoolBrigham and Women's Hospital
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