Androgen-deprivation therapy (ADT) entails lowering serum testosterone levels to castrate levels and forms a cornerstone of the management of hormone-sensitive advanced prostate cancer; however, the benefit of ADT is partially offset by its detrimental metabolic and cardiovascular adverse effects. ADT decreases insulin sensitivity while promoting dyslipidemia and sarcopenic obesity, which leads to an increased risk of cardiovascular morbidity and potentially mortality. The risk seems to be highest in elderly patients who have had recent cardiovascular events before starting ADT. It is prudent to engage in an individualized risk-benefit discussion and develop a cohesive multidisciplinary management plan to medically optimize and closely observe these patients before and during treatment with ADT.Careful history taking and physical examination to diagnose, treat, and optimize active CV disease with guideline-directed therapy before starting androgen-deprivation therapyConsider metformin for diabetes, ACEIs for HTN, aspirin for vascular health, and statins for hyperlipidemia in eligible patientsSmoking cessation, lifestyle modification, exercise, and stress reduction must be emphasized in all patients Awareness to seek immediate medical attention for new or worsening CV symptoms Abbreviations: ACEI, angiotension-converting enzyme inhibitor; CV, cardiovascular; HTN, hypertension.

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