Taiwan Consensus for the Management of Cardiovascular Risks and Complications in Patients with Prostate Cancer

Abstract

Prostate cancer (PC) is one of the leading causes of cancer-related deaths among men globally, and it frequently coexists with cardiovascular disease (CVD). With increasing cancer survival rates and an aging population, the incidence of CVD among PC patients is also on the rise. The treatments for PC include androgen deprivation therapy, androgen receptor pathway inhibitors, and docetaxel-based chemotherapy, and the cardiovascular complications include hypertension, metabolic syndrome, heart failure and arrhythmias. As it is important to provide personalized treatment planning and close monitoring, cardio-oncology collaboration plays a crucial role in optimizing treatment outcomes, emphasizing cardiovascular risk assessments and tailored treatment plans that balance cancer control and cardiovascular health. In this consensus statement, we review several important issues including the association between CVD and PC, screening for cardiovascular diseases and risk factors, timing and criteria for cardiology referral, cardiovascular risk assessments and management, and multidisciplinary collaboration and patient education. However, challenges remain in screening and preventive measures, and future research should focus on developing robust cardiovascular risk assessment tools, preventive measures, and interdisciplinary approaches to improve patient outcomes and reduce cardiovascular morbidity in patients being treated for PC.

Keywords: Androgen deprivation therapy; Androgen receptor pathway inhibitors; Cardio-oncology; Cardiovascular disease; Prostate cancer.

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Figure 1

Risk stratification and management of cardiovascular risk factors and pre-existing cardiovascular disease in patients with prostate cancer. ACS, acute coronary syndrome; AR, androgen receptor; ARPI, androgen receptor pathway inhibitor; ASCVD, atherosclerotic cardiovascular disease; DOAC, direct oral anti-coagu-lants; HbA1C, glycated hemoglobin; LHRH, luteinizing-hormone releasing hormone; PCI, percutaneous coronary intervention; STEMI, ST-elevation myocardial infarction.

Figure 2

Proposed flowchart for atherosclerotic cardiovascular disease risk assessment and follow-up in patients with prostate cancer. * ASCVD: CAD, stroke, peripheral artery disease. ^† An LHRH antagonist should be considered in patients with pre-existing symptomatic CAD who require ADT. ^δ Definition of metabolic syndrome ≥ 3 of the following measurements: abdominal obesity (waist circumference ≥ 90 cm in men), triglyceride level ≥ 150 mg/dL, HDL-C < 40 mg/dL in men, systolic blood pressure ≥ 130 mmHg or diastolic blood pressure ≥ 85 mmHg, and fasting glucose ≥ 100 mg/dL. ^# Risk factors: Age (male > 45), hypertension, diabetes, dyslipidemia, cigarette use, family history of CVD and metabolic syndrome. ADT, androgen deprivation therapy; ASCVD, atherosclerotic cardiovascular disease; CAD, coronary artery disease; CT-RCD, cancer therapy-related cardiac dysfunction; CV, cardiovascular; CVD, cardiovascular disease; ECG, electrocardiogram; HbA1C, glycated hemoglobin; HDL-C, high-density lipoprotein cholesterol; LHRH, luteinizing-hormone releasing hormone; MACE, major adverse cardiovascular event.

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Figure 3

Summary of the key merits of cardiac monitoring in patients with prostate cancer undergoing treatment. CV, cardiovascular; ECG, electrocardiogram.