Cardiometabolic side effects of androgen deprivation therapy in prostate cancer

Abstract

Purpose of reviewAndrogen-deprivation therapy (ADT) is widely employed for treatment of advanced prostate cancer and it is considered the frontline therapy. However, the numerous adverse reactions associated with this treatment option are concerning and its potential association with cardiovascular diseases (CVD) should not be overlooked. In this review, we examine the literature on the cardiovascular side effects of ADT and the physiologic mechanisms underpinning the association with CVD. We will also specifically discuss the different findings regarding the interesting potential disparity in major cardiovascular events among GnRH agonist-treated patients compared with patients undergoing GnRH antagonist treatment.Recent findingsAndrogen-deprivation therapy increases the risk of developing CVD by altering the body composition, metabolism, vascular system, and cardiac physiology. GnRH agonists may pose a higher risk of cardiovascular mortality and morbidity than GnRH antagonists; however, this link remains to be determined. Furthermore, screening for cardiovascular risk factors before and during ADT treatment is a crucial step in preventing major adverse cardiac events in prostate cancer patients. Notably, preexisting CVD and comorbidities have been identified as major key elements predicting cardiovascular events. Early implementation of pharmacological and nonpharmacological treatment strategies is strongly suggested, and regular follow-up visits should be scheduled to continuously assess patients’ cardiovascular risk under ADT.SummaryADT is a very powerful treatment option for advanced prostate cancer that improves survival outcomes but has the potential of considerably impacting patients’ cardiovascular health. Medical optimization and close monitoring are crucial during treatment with ADT.

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“…Androgendeprivation therapy (ADT) is commonly used as the first-line therapy for the treatment of advanced prostate cancer. However, this therapy is associated with numerous adverse reactions that cannot to be overlooked (Lafontaine and Kokorovic, 2022). Once the disease progresses to castration-resistant prostate cancer (CRPC), docetaxel is the main remaining drug that has been proven to provide a survival benefit in metastatic CRPC.…”