Key result
Adding ADT to radiation therapy linked to ~54% lower MACE risk in prostate cancer.
Why the study?
Androgen deprivation therapy combined with radiation therapy may increase risk for major adverse cardiovascular events in men with prostate cancer, with uncertain racial differences in risk.
Does androgen deprivation therapy combined with radiation therapy reduce MACE in Veterans with prostate cancer compared to radiation therapy alone?
Cohort (n=39,580)
Yes
Does androgen deprivation therapy combined with radiation therapy reduce MACE in Veterans with prostate cancer compared to radiation therapy alone?
Hazard Ratio: 0.46 (95% CI 0.27–0.78)
Pre-existing cardiometabolic disease significantly amplifies the risk of MACE in veterans treated for prostate cancer, highlighting the critical need for pre-treatment cardiovascular risk screening and optimization.
May inform ADT decisions in prostate cancer without cardiometabolic disease; hypothesis-generating pending randomized confirmation.
BACKGROUND: Androgen deprivation therapy (ADT) is the cornerstone treatment strategy for men diagnosed with high-risk prostate cancer (PC) but may increase risk for major adverse cardiovascular events (MACE). We examined whether men treated with ADT and radiation therapy (ADT + RT) developed MACE at a higher rate than men receiving RT alone. Secondly, we sought to determine if Black men receiving RT + ADT developed MACE at a higher rate than White men. METHODS: This retrospective cohort study examined time to diagnosis of MACE among Veterans with PC. We used a 1:1 propensity score matching process to determine whether treatment type (ADT + RT vs. RT alone), race (Black vs. White men) or having a previous diagnosis of a cardiometabolic disease (CMD) were associated with differences in the rate at which men develop MACE. RESULTS: Veterans with PC were White (68%) and Black (32%). At PC diagnosis, the mean age was 65.9 years. The majority had stage 2 disease (83.0%) classified as intermediate risk (43.1%). Treatment-matched models showed men receiving ADT + RT were less likely to develop MACE when they no pre-existing CMD. Men treated with ADT + RT or RT alone had significantly increased risks of MACE is they had pre-existing CMD. Black men had the same risk of MACE as non-Hispanic Whites. CONCLUSIONS: Preexisting CMD and multimorbidity are significant risks for MACE among men treated for PC within the VA healthcare system whether treated with ADT + RT or with RT alone, highlighting the importance pretreatment optimization of comorbidities.
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Lucas et al. (2025) conducted a cohort in Prostate cancer (n=39,580). Androgen deprivation therapy plus radiation therapy vs. Radiation therapy alone was evaluated on Time to major adverse cardiovascular events (composite of cardiovascular death, myocardial infarction, or ischemic stroke) (HR 0.46, 95% CI 0.27-0.78). Among Veterans with prostate cancer without pre-existing cardiometabolic disease, receiving androgen deprivation therapy plus radiation therapy was associated with a lower rate of major adverse cardiovascular events compared to radiation therapy alone (HR 0.46).
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