Prostate cancer is the most common noncutaneous cancer diagnosed in men in the United States and the second leading cause of cancer death.1 In 2015, there were an estimated 3 million prostate cancer survivors in the United States; this number will reach 4 million in the next decade.1 Because of the indolent, slowly progressive disease course of prostate cancer and advances in early detection and effective treatment, non–cancer-related deaths are the most common causes of mortality.2 In particular, given the prevalence of pre-existing and new cardiovascular disease (CVD), ischemic heart disease is the most common noncancer cause of death in patients with prostate cancer.2
Androgen deprivation therapy (ADT) is the primary systemic therapy for locally advanced and metastatic prostate cancer, with as many as 50% of patients receiving ADT at some point during their disease course.3 Several observational studies suggest a link between ADT and increased risk of cardiovascular events.4 In 2010, the American Heart Association released a statement acknowledging the possible association between ADT and adverse cardiovascular events.5 More recently, the prostate cancer survivorship care guidelines by American Society of Clinical Oncology endorsed evaluation and screening of cardiovascular risk factors in men receiving ADT.6 Given the growing population of prostate cancer patients and survivors receiving ADT, it is crucial for practicing physicians to better understand ADT and the possible association with CVD.
Circulation. 2016 Feb 02 [Epub]
Authors: Nirmanmoh Bhatia, Marilia Santos, Lee W Jones, Joshua A Beckman, David F Penson, Alicia K Morgans, Javid Moslehi
1. DeSantis, Carol E., Chun Chieh Lin, Angela B. Mariotto, Rebecca L. Siegel, Kevin D. Stein, Joan L. Kramer, Rick Alteri, Anthony S. Robbins, and Ahmedin Jemal. “Cancer treatment and survivorship statistics, 2014.” CA: a cancer journal for clinicians 64, no. 4 (2014): 252-271.
2. Epstein, Mara M., Gustaf Edgren, Jennifer R. Rider, Lorelei A. Mucci, and Hans-Olov Adami. “Temporal trends in cause of death among Swedish and US men with prostate cancer.” Journal of the National Cancer Institute 104, no. 17 (2012): 1335-1342.
3. Conteduca, Vincenza, Giuseppe Di Lorenzo, Alfredo Tartarone, and Michele Aieta. “The cardiovascular risk of gonadotropin releasing hormone agonists in men with prostate cancer: an unresolved controversy.” Critical reviews in oncology/hematology 86, no. 1 (2013): 42-51.
4. Nguyen, Paul L., Shabbir MH Alibhai, Shehzad Basaria, Anthony V. D’Amico, Philip W. Kantoff, Nancy L. Keating, David F. Penson, Derek J. Rosario, Bertrand Tombal, and Matthew R. Smith. “Adverse effects of androgen deprivation therapy and strategies to mitigate them.” European urology 67, no. 5 (2015): 825-836.
5. Levine, Glenn N., Anthony V. D’Amico, Peter Berger, Peter E. Clark, Robert H. Eckel, Nancy L. Keating, Richard V. Milani, Arthur I. Sagalowsky, Matthew R. Smith, and Neil Zakai. “Androgen-deprivation therapy in prostate cancer and cardiovascular risk: a science advisory from the American Heart Association, American Cancer Society, and American Urological Association: endorsed by the American Society for Radiation Oncology.” Circulation 121, no. 6 (2010): 833-840.
6. Resnick, Matthew J., Christina Lacchetti, Jonathan Bergman, Ralph J. Hauke, Karen E. Hoffman, Terrence M. Kungel, Alicia K. Morgans, and David F. Penson. “Prostate cancer survivorship care guideline: American Society of Clinical Oncology clinical practice guideline endorsement.” Journal of Clinical Oncology 33, no. 9 (2015): 1078-1085.
From Cardiovascular Division (N.B., J.A.B., J.M.), Cardio-Oncology Program (N.B., J.M.), Vanderbilt-Ingram Cancer Center (D.F.P., A.K.M., J.M.), and Department of Urologic Surgery (D.F.P., A.K.M.), Vanderbilt University School of Medicine, Nashville, TN; Cardio-Oncology Service, Sirio-Libanes Hospital, Sao Paulo, Brazil (M.S.); Department of Cardiology, Sao Paulo Cancer Institute (ICESP), University of Sao Paulo, Brazil (M.S.); and Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (L.W.J.)., From Cardiovascular Division (N.B., J.A.B., J.M.), Cardio-Oncology Program (N.B., J.M.), Vanderbilt-Ingram Cancer Center (D.F.P., A.K.M., J.M.), and Department of Urologic Surgery (D.F.P., A.K.M.), Vanderbilt University School of Medicine, Nashville, TN; Cardio-Oncology Service, Sirio-Libanes Hospital, Sao Paulo, Brazil (M.S.); Department of Cardiology, Sao Paulo Cancer Institute (ICESP), University of Sao Paulo, Brazil (M.S.); and Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (L.W.J.). .