Key result
Three-tier triage schema classifies CV risk to guide referral in prostate cancer hormone therapy.
Why the study?
Population-based cardiovascular risk calculators do not account for treatment-related effects of ADT and ARPis in prostate cancer and lack validation across treatment states.
Proposes a pragmatic, point-of-care cardiovascular risk triage schema for prostate cancer patients on hormone therapy to guide referral and risk factor optimization.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“General population risk scores that we've been recommended to use are not ideally predicting who is at an increased risk for developing a major adverse cardiovascular event. Until we have better risk scores, we need to be extremely proactive as clinicians and oncologists at getting our patients on risk-lowering therapies, including statins and appropriate blood pressure monitoring and management, and get them plugged into primary care providers and cardiologists, because we know those do lower the risk of cardiovascular events.”
“In a lot of patients, ASCVD doesn't seem to really capture big changes after we start men on hormone therapy, yet we know that when we start these hormone therapies, we increase the risk for heart attacks, strokes and cardiovascular deaths. This validates my clinical experience and reinforces that we need to start studying these risk tools in bigger cohorts of men with prostate cancer.”
“This important international study works to establish an evidence base of who benefits and how they may benefit from cardiovascular and internist management of risk.”
May guide CVD triage in prostate cancer patients on ADT/ARPis; leaves open prospective validation before practice change.
Importance Cardiovascular disease (CVD) is a leading noncancer cause of death among patients with prostate cancer (PC). Population-based risk calculators do not account for treatment-related effects of androgen-deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPis), and they have not been validated across PC treatment states. Observations This Prostate Cancer Foundation–sponsored clinician-industry consensus and narrative review proposes a pragmatic identification and triage schema for point-of-care use. The schema supports rapid risk capture, tier assignment, and referral or risk-factor optimization triggers; it does not provide cardiovascular therapeutic algorithms. We synthesize evidence on baseline cardiometabolic burden, ADT-associated adiposity and muscle-strength changes, plaque progression, ARPi-associated hypertension and cardiac events, suboptimal real-world risk-factor control, and social-needs barriers. Patients are classified as high risk when they have prior major cardiovascular events or established clinical atherosclerotic CVD; intermediate risk when they have no prior event but at least two uncontrolled or adverse risk factors; and low risk when neither criterion is met. We clarify cutpoints, the rationale for operational thresholding, essential versus optional intake elements, and capacity-sensitive referral pathways. Conclusion and Relevance The proposed three-tier schema should be viewed as a hypothesis-generating checklist for oncology, urology, radiation oncology, primary care, and cardiovascular teams. Prospective validation, workflow testing, calibration of referral thresholds, and inclusion of patient and clinic-staff stakeholders are required before broad implementation.
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Guha et al. (2026) conducted a review in Prostate cancer treated with hormone therapy. Cardiovascular Risk Triage Schema was evaluated. A proposed three-tier cardiovascular risk triage schema classifies patients with prostate cancer on hormone therapy into high, intermediate, and low risk to guide referral and risk-factor optimization.
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