Cardiovascular disease should be considered a comorbidity of particular concern in the treatment of prostate cancer

This study is the first to investigate the prevalence and risks of cardiovascular disease (CVD) among newly diagnosed prostate cancer patients in China. Clinical data from 2010 to 2022 were retrospectively collected from 34 centers nationwide, incorporating a total of 4,253 prostate cancer patients. The results indicate that 27.0% of patients had concurrent prostate cancer and cardiovascular disease, while 7.2% suffered from two or more cardiovascular conditions. Additionally, cardiovascular risk was assessed using the Framingham Risk Score (FRS), revealing an increased risk associated with advancing age and the presence of metabolic disorders. This research provides epidemiological evidence of the comorbidity of prostate cancer and cardiovascular disease, and offers recommendations for evaluating and managing cardiovascular risk during prostate cancer treatment.

Prostate cancer, as the most prevalent and deadly malignancy among male urological tumors, constitutes a significant global health burden. Androgen deprivation therapy (ADT) is commonly used as a primary treatment for advanced or recurrent cases of prostate cancer. However, this therapy has been shown to significantly increase the risk of cardiovascular disease, which has increasingly become one of the leading causes of death among patients with prostate cancer. There are many shared risk factors between cardiovascular disease and cancer. For instance, patients with prostate cancer who have pre-existing cardiovascular disease exhibit a markedly increased risk of major adverse cardiovascular events, such as heart attacks and strokes, following ADT. This increased risk underscores the need for a comprehensive assessment of cardiovascular health before implementing prostate cancer treatment strategies and developing corresponding management plans. With the extension of average life expectancy and continuous improvements in treatment strategies, an increasing number of prostate cancer survivors will have to confront the cardiac toxicity risks posed by ADT. Therefore, it becomes particularly important to perform baseline cardiovascular epidemiological and risk assessments for prostate cancer patients prior to initiating cancer treatments that could induce cardiac toxicity. This study aims to improve overall treatment strategies and enhance patient quality of life by exploring the prevalence and risk assessment of cardiovascular diseases in a cohort of newly diagnosed prostate cancer patients in China.

This study employed a convenience sampling method to retrospectively collect clinical data from newly diagnosed prostate cancer patients across 34 medical centers nationwide from 2010 to 2022. The study aimed to investigate the prevalence and risk assessment of CVD in these patients. Cardiovascular diseases included in this definition comprise myocardial infarction, arrhythmias, heart failure, stroke, and ischemic heart disease, among others. To assess cardiovascular risk, the FRS was utilized—a widely used scoring system that estimates an individual's future risk of developing cardiovascular disease. Based on the FRS outcomes, participants were categorized into three risk levels: low risk (FRS <10%), moderate risk (FRS 10%-20%), and high risk (FRS >20%). This stratification method enabled a more detailed analysis of data from patients across different risk groups. Additionally, baseline demographic information, clinical and metabolic data, and other factors potentially affecting cardiovascular health were collected.

In this study involving prostate cancer patients, the majority, over 60 years of age, primarily reside in urban areas, accounting for approximately 70% of the sample. Data indicate that nearly 90% of the patients were diagnosed in 2016 or later. The study encompasses multiple geographic regions across China, providing comprehensive demographic information that aids in further epidemiological analysis and the formulation of health management strategies.

This study analyzed the clinical characteristics of 4,253 prostate cancer patients. The data reveal that approximately half of the patients had serum PSA levels ranging from 10 to 50 ng/mL, and 30.6% of the patients exhibited PSA levels exceeding 50 ng/mL. About 12% of the patients did not undergo multiparametric magnetic resonance imaging (mpMRI), predominantly older individuals and those from economically disadvantaged areas. Among patients who underwent mpMRI, there was a significant number of missing PI-RADS scores. Pathological grading indicated a roughly even distribution across ISUP grades 2, 3, and 4, while the proportions for grades 1 and 5 were 13.6% and 25.0%, respectively. In terms of disease staging, approximately 57.5% of the patients were diagnosed with localized lesions, 20.5% with locally advanced disease, and another 20.5% displayed metastatic disease. Regarding treatment choices, about 46.6% of the patients underwent radical prostatectomy, and 45.7% received treatment regimens that included ADT.

In this study, the authors analyzed data from 1,944 newly diagnosed prostate cancer patients who received ADT, finding that only a small minority (80 patients) opted for surgical castration. The majority of patients were treated pharmacologically, with the vast majority receiving gonadotropin-releasing hormone (GnRH) agonists, and only a few using GnRH antagonists. The study specifically noted that patients with a history of cardiovascular disease more frequently chose GnRH antagonists, indicating that in selecting ADT treatment options, there is a preference for therapies with less cardiovascular impact, reflecting the need to minimize cardiovascular event risks. This finding underscores the importance of considering patients' cardiovascular health comprehensively when treating prostate cancer.

In this study, the authors employed the FRS to assess the cardiovascular disease risk for prostate cancer patients without a known history of cardiovascular disease. According to the FRS results, patients were categorized into three risk levels: low risk (FRS <10%), moderate risk (FRS 10%-20%), and high risk (FRS >20%). The study revealed that the risk of cardiovascular disease significantly increased with patient age. Additionally, patients with higher body mass index (BMI) also exhibited increased cardiovascular risk. These findings emphasize the need to consider these cardiovascular risk factors when treating prostate cancer patients, in order to implement appropriate preventive and management measures to improve treatment outcomes and quality of life.

This study demonstrates that the risk of CVD increases for prostate cancer patients undergoing ADT, particularly for those with pre-existing cardiovascular conditions. Therefore, it is essential to assess and manage cardiovascular health before initiating ADT for these patients. It is recommended to perform a comprehensive cardiovascular disease risk assessment prior to treatment and to closely monitor cardiovascular status during therapy to reduce the risk of adverse cardiovascular events. Additionally, opting for ADT treatment options that have a lesser impact on cardiovascular health, such as using GnRH antagonists instead of agonists, may help to preserve cardiovascular health.