Heart Disease Is Most Common Cause of Death for Prostate Cancer Survivors

Survivors of prostate cancer should be made aware of an increased risk for heart disease. It is the most common noncancer cause of death for men with prostate cancer, according to a recent publication in Circulation.1

Early detection, effective treatment, and the disease's slow progression mean that most of the 3 million survivors of prostate cancer in the United States will die from something other than cancer. Cardiovascular disease is particularly a concern for men who received androgen-deprivation therapy (ADT) to treat their prostate cancer.

"While ADT therapy is of great benefit to many patients with prostate cancer, it may also increase the risk of developing diabetes or having a heart attack or stroke. By collaborating with urology, medical oncology, and the cardio-oncology program, we are better able to determine which patients are most likely to benefit from hormones, and in those who do get hormones, how to better protect their cardiovascular system," said Eric Shinohara, MD, MSCI, associate professor of Medicine and medical director of the Vanderbilt Radiation Oncology Clinic in Nashville, Tennessee.

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Serum testosterone levels are reduced by ADT, and that can cause prostate cancers to shrink or grow more slowly. Unfortunately, ADT appears to have an association with increased levels of low-density lipoprotein and triglycerides, increased fat, decreased lean body mass, increased insulin resistance, decreased glucose tolerance, and a metabolic state that is generally similar to metabolic syndrome.

"Aggressive treatment of these altered cardiovascular risk factors can be an important step to decrease the risk of heart attack and stroke in patients treated with ADT," said Javid Moslehi, MD, assistant professor of Medicine and director of Vanderbilt's Cardio-oncology program, and senior author of the study.

Cardiovascular wellness in general is an important aspect of care for the nearly 230 000 men who receive prostate cancer diagnosis each year in the United States.

The researchers describe the ABCDE algorithm: A is for awareness and aspirin; B, blood pressure; C, cholesterol and cigarette; D, diet and diabetes; and E, exercise. The algorithm is adopted into the survivor guidelines from the National Comprehensive Cancer Network (NCCN). The range of specialists who comprise a patient's cardio-oncology program share responsibility for educating patients about their risks and what they can do to address them.

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"Collaboration among subspecialties in medicine is critical to maintaining the health of our patients. No one is simply a prostate or a heart, and the treatments we use to treat one illness or another can dramatically affect the well-being of other parts of a patient. Bringing together a comprehensive team that addresses all facets of a patient's health allows us to provide the best medical care there is," said Alicia Morgans, MD, MPH, assistant professor of Medicine at Vanderbilt, and coauthor of the study.

REFERENCE

1. Bhatia N, Santos M, Jones LW, et al. Cardiovascular effects of androgen deprivation therapy for the treatment of prostate cancer: ABCDE steps to reduce cardiovascular disease in patients with prostate cancer. Circulation. 2016;133(5):537-541.

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