Cardiac Function and Prostate Cancer Risk and Prognosis: The PROCA-Life Study

Background and Objective Prostate cancer (PCa) risk and the total cardiovascular disease (CVD) burden increases with age. The main objective was to evaluate the interplay between cardiac function and PCa risk and prognosis. Methods In the population-based cohort Prostate Cancer Study throughout life (PROCA-life), 2 514 men participating in the Tromsø Study (1994-2016) had echocardiographic examinations. Overall, 235 were diagnosed with PCa during follow-up. Cox proportional hazard models were used to study associations between pre-diagnostic cardiac function and PCa risk and mortality. Results Mean time from echocardiography to PCa was 9.9 years for men with high risk/metastatic PCa, and the 10-year survival rate was 78.3 % among high risk/metastatic PCa. Men aged >60.3 years at study entry with mitral peak E deceleration time (DT) <140 ms or DT>220 ms had a 1.66-3.37 times higher probability of high risk/metastatic PCa compared with men with normal DT (140-220 ms). Among men who developed PCa, low or high DT was associated with higher overall mortality compared to men with normal DT (HR 3.35, 95% CI 1.35-8.33 and HR 2.00, 95% CI 1.28-3.14, respectively). DT > 220 ms was associated with two times higher PCa-specific mortality (HR 2.09, 95% CI 1.11-3.94). Conclusions and Clinical Implications Pre-diagnostic diastolic dysfunction may be associated with an increased risk of high risk/metastatic PCa, as well as higher overall mortality and PCa-specific mortality. These results support that cardiovascular follow-up among men with PCa is important. Micro Abstract Cardiovascular disease (CVD) is the most common non-oncologic cause of death, and our study aimed to evaluate the interplay between cardiac function and Prostate cancer (PCa) by using the population-based cohort Prostate Cancer Study throughout life (PROCA-life). Overall, 235 out of the 2 514 men with one or more echocardiography, were diagnosed with PCa during follow-up. Men aged >60.3 years at study entry with mitral peak E deceleration time (DT) <140 ms or DT>220 ms had a 1.66-3.37 times higher probability of high risk/metastatic PCa compared with men with normal DT (140-220 ms), and DT > 220 ms was associated with two times higher PCa-specific mortality (HR 2.09, 95% CI 1.11-3.94). Our study supports that pre-diagnostic diastolic dysfunction may be associated with an increased risk of high risk/metastatic PCa, as well as higher PCa-specific mortality.