Cardiovascular Risks of Hormonal Treatment in Prostate Cancer

Introduction to Cardiovascular Risks

The European Society for Medical Oncology recommends that hormonal treatment for prostate cancer should be carefully managed to minimize cardiovascular risks, especially in patients with pre-existing cardiovascular diseases 1, 2

Androgen deprivation therapy (ADT) can cause or worsen several cardiovascular risk factors, including weight gain and obesity, which is associated with an increased risk of cardiovascular disease 3
The American College of Cardiology recommends that patients undergoing ADT should be monitored for changes in lipid profiles and glucose metabolism, as these changes can increase the risk of cardiovascular disease 3

The European Association of Urology recommends that a comprehensive assessment of cardiovascular risk factors should be performed before starting ADT, especially in patients over 65 years old with pre-existing cardiovascular comorbidities 4
Patients with high-risk prostate cancer who require radiation therapy should receive neoadjuvant and concomitant hormonal therapy for 4-6 months, followed by adjuvant hormonal therapy for 2-3 years, as recommended by the American Society for Radiation Oncology 4
The American Heart Association recommends that patients treated with LHRH agonists should be informed that regular physical exercise can help reduce fatigue and improve quality of life 5, 6

For patients with locally advanced prostate cancer, intermittent androgen deprivation therapy (IAD) may be considered as an alternative to continuous androgen deprivation, with potential benefits on quality of life and reduced cardiovascular side effects 7
The European Society for Medical Oncology recommends that bicalutamide 150 mg daily may be considered as an alternative to LHRH agonists in patients who prefer its toxicity profile, although long-term outcome data are limited 5, 6