Key result
Androgen-deprivation therapy is linked to higher cardiovascular risk, but routine screening is not recommended.
Why the study?
Recent studies have reported an association between androgen-deprivation therapy for prostate cancer and increased cardiovascular risk, prompting the need to evaluate metabolic effects and cardiovascular event data.
Does androgen-deprivation therapy increase the risk of cardiovascular events and mortality in men with prostate cancer?
Does androgen-deprivation therapy increase the risk of cardiovascular events and mortality in men with prostate cancer?
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Certain cancer treatments can increase a patient's risk of heart disease, atherosclerosis and diabetes, just to name a few. By using this algorithm, we may be reducing these risks and ultimately avoiding adverse outcomes in these at-risk patients.”
“This study offers more evidence to inform that discussion: namely that there is a survival benefit with the use of hormone therapy in intermediate-risk disease, and that concerns of dying due to cardiac causes should be somewhat relieved given that this does not appear to be the case.”
Although ADT may increase cardiovascular risk via adverse metabolic effects, routine referral for cardiac evaluation before initiation is not required, but strict secondary prevention is advised for those with established cardiovascular disease.
Androgen-deprivation therapy (ADT) is a widely used treatment for prostate cancer. Recently, several studies have reported an association between ADT and an increased risk of cardiovascular events, including myocardial infarction and cardiovascular mortality.1-5 These reports have led to increased interest and discussion regarding the metabolic effects of ADT and its possible association with increased cardiovascular risk. In addition, likely as a result of these reports, internists, endocrinologists, and cardiologists are now being consulted regarding the evaluation and management of patients in whom ADT is being initiated. Most of these physicians are not aware of the possible effects of ADT on cardiovascular risk factors or the issues regarding ADT and cardiovascular disease. Therefore, this multidisciplinary writing group has been commissioned to review and summarize the metabolic effects of ADT, to evaluate the data regarding a possible relation between ADT and cardiovascular events in patients with prostate cancer, and to generate suggestions regarding the evaluation and management of patients, both with and without known cardiac disease, in whom ADT is being initiated (Table 1). TABLE 1 Prospective Studies of the Effects of ADT on Cardiac Risk Factors ADT was first used in prostate cancer for patients with overt metastatic disease,7 and it remains the mainstay of therapy for this group. ADT combined with external-beam radiation therapy is a standard of care in the treatment of men with high-risk prostate cancer, on the basis of evidence that shows a survival benefit in multiple randomized controlled trials.8-13 However, ADT is also often used for other prostate cancer states (eg, for prostate volume reduction in men planning to undergo definitive local therapy with brachytherapy, or in the case of rising prostate-specific antigen after definitive local treatment),14,15 and in these cases, its role in prolonging survival is less certain.
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Levine et al. (2010) conducted a review in Prostate cancer. Androgen-deprivation therapy (ADT) vs. No ADT was evaluated on Incident cardiovascular events and cardiovascular mortality. Androgen-deprivation therapy in prostate cancer may be associated with an increased risk of cardiovascular events and adverse metabolic alterations, though routine pre-treatment cardiac testing is not recommended.
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