Evaluating Clinical Tools to Monitor Cardiovascular Risk in Men With Prostate Cancer Receiving Hormone Therapy

PURPOSE: Men with prostate cancer face considerable cardiovascular (CV) comorbidity. Androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPIs) elevate this risk, yet no prostate-specific CV monitoring tools exist. Clinicians rely on general calculators such as the American Heart Association (AHA)/American College of Cardiology (ACC) atherosclerotic cardiovascular disease (ASCVD) score, which remain unvalidated in this setting. The purpose of this study is to evaluate changes in the estimated CV risk of men with prostate cancer after 6 months of hormone therapy using clinical tools established for the general population. METHODS: This was a post hoc analysis of sixty-three men with localized high-risk prostate cancer treated with 6 months of preoperative ADT plus apalutamide with or without abiraterone on a trial (ClinicalTrials.gov identifier: NCT03279250). ASCVD risk and metabolic syndrome (MetS) Z scores were calculated at baseline and the end of treatment using AHA/ACC and MetS calculators. RESULTS: After 6 months of ADT plus ARPI, the median ASCVD risk score increased modestly (+0.95), with 21% exhibiting a clinically significant increase (≥2.5%). This was primarily driven by increases in total cholesterol (median, 182-211) and low-density lipoprotein (median, 101-122), whereas blood pressure did not have a clinically significant change. Five patients experienced a major adverse CV event, yet only one had a clinically significant increase in ASCVD risk score. Only 28% of patients experienced an increase in MetS risk. CONCLUSION: After 6 months of ADT plus ARPI, men with prostate cancer showed worsening lipid profiles and 21% had worsening of their CV risk based on general population tools. These findings highlight the unmet need to develop prostate cancer-specific CV risk assessment tools.