Treating PCa with ADT and Minimizing Cardiovascular Risk: a Therapeutic Tightrope

How to Treat Prostate Cancer With Androgen Deprivation and Minimize Cardiovascular Risk: A Therapeutic Tightrope (2021, Full Text) [With two case studies]

"Highlights

• Androgen deprivation therapy is associated with metabolic derangements due to profound hypogonadism that can increase the risk of CV disease in prostate cancer survivors.

• Therapeutic advances have resulted in prolonged patient exposure to androgen deprivation therapy, thereby increasing CV complications for many prostate cancer survivors.

• A systematic approach to monitoring and addressing reversible CV risk factors and purposeful engagement in multidisciplinary care between oncologists, urologists, and cardiologists is critical to optimizing CV outcomes in men with prostate cancer.
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Androgen deprivation therapy (ADT) is the primary systemic therapy for men with high-risk localized, recurrent, or advanced prostate cancer due to the cancer’s dependence on oncogenic androgen receptor signaling. ADT is most commonly delivered through medical castration with the use of gonadotropin-releasing hormone (GnRH) agonists or antagonists that cause profoundly low testosterone and estrogen levels and result in deep anticancer responses. ADT is used in up to 40% of men with prostate cancer at some point during the course of their treatment, with curative intent for men with localized intermediate- or high-risk disease, and with palliative intent for men with advanced/metastatic prostate cancer. Although it is associated with excellent cancer control outcomes, the hormonal shifts from ADT cause negative cardiometabolic consequences that must be recognized and managed. This is particularly critical in prostate cancer survivors with pre-existing cardiovascular disease (CVD) or cardiovascular risk factors (CVRFs), as they are at highest risk of cardiovascular complications during treatment with ADT."

(See the Full Text)

Djin

Djin thanks for posting this, I’ve bookmarked it in case I need adt in the future.

This is something that RO,s often don’t address. My RO, one of the top in the country as I understand it, at MSKCC did not, and when I asked about it he glossed over it, saying evidence is not strong enough, or something to that effect.

Something surer than that...we will all die from something...which comforts me...I guess the point is...if there is one...one can take you to the gateway of eternity ( an instant ),,.the other can take an eternity to the gateway...Sophie's Choice...

My college physiology prof pointed out that drugs don't have side effects-- just effects. The one's we're not interested in are dubbed side effects, but this downplays them.

We often hear about PCa that "you'll likely die of something else"--the "tightrope" in the paper's title emphasizes that in staving off death from PCa, you don't want to hasten your demise from "something else"

Djin

garyi said...

Pratoman said...
This is something that RO,s often don’t address. My RO, one of the top in the country as I understand it, at MSKCC did not, and when I asked about it he glossed over it, saying evidence is not strong enough, or something to that effect.

Not 'only' RO's but most all physicians, in my experience. They just don't know, and find it all but impossible to admit that, so they don't bring it up. The myriad types of side effects, and the infinite differences in each of us, make understanding them just as difficult as finding effective, long lasting treatments. It's a risk/reward leap of faith every time.

BTW, Prato, the celebrity "top notch" cardiothoracic surgeon at MSKCC, who operated on RBG, and that I'm in talks with about radical surgery to remove my chest DDLPS also has trouble spelling 'side effects'. All too often the cure is as bad as the symptom.

Faith, hope, prayer, lots of in-depth research, then a jump into the great unknown. Good luck to all of you!

Good luck Gary, with the surgeon, i hope you find a resolution.

The biggest take away I got if you do have CV which I do, then it is important to be on meds for the heart and BP.
This article gives me some hope....
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.056810
Cardiovascular Safety of Degarelix Versus Leuprolide in Patients With Prostate Cancer: The Primary Results of the PRONOUNCE Randomized Trial

I just skimmed the full text because there was a lot to take in for my Lupron brain. Maybe Relugolux will end up being a better choice than Lupron. Maybe not using ADT with RT will be a better choice for certain patients. For the lifetime ADT guys there isn't much choice beyond accepting the chance of a cardiac event.

I guess we need to be proactive to make sure our blood pressure is good and our heart rhythms are good, and not make the assumption that our doctors have us covered in every way. A good body weight, diet, exercise, and generally healthy lifestyle might help.