Clinicians may need to be more proactive in preventing and treating cardiovascular disease (CVD) in patients with prostate cancer who are receiving androgen deprivation therapy (ADT), according to researchers at Vanderbilt University in Nashville, TN.1 They reported that collaboration among subspecialties in medicine may be critical to preventing CVD deaths, the most common non-cancer cause of death for men with prostate cancer.

Partially developed by a team of researchers at the Vanderbilt University School of Medicine’s Cardio-Oncology Program, the  ABCDE paradigm, an algorithm for cardiovascular health in cancer survivors, is being adapted for prostate cancer as part of national cancer survivorship guidelines by the National Comprehensive Cancer Network (NCCN) in the absence of formal guidelines. It may be highly beneficial for guiding therapeutic interventions in a way previously not possible.

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The ABCDE algorithm for prostate cancer survivors includes awareness and aspirin; blood pressure monitoring; cholesterol management and cigarette avoidance; diet and diabetes; and exercise. Senior study author Javid Moslehi, MD, who is an assistant professor of medicine and director of Vanderbilt’s Cardio-Oncology Program, said ADT has been associated with increased low-density lipoprotein and triglyceride levels. It has also been associated with increased fat and decreased lean body mass. Dr Moslehi said aggressive treatment of these altered CVD risk factors may significantly reduce CVD events.

“It is arguably one of the biggest issues in oncology,” Dr Moslehi said in an interview with Cancer Therapy Advisor. “It is one of the areas that is fastest growing in cardiology because the oncologists are doing such a good job, but some of the therapies affect the heart.”

Currently, ADT is the primary systemic therapy for locally advanced and metastatic prostate cancer and for prostate volume reduction in men planning to undergo definitive local therapy with brachytherapy. It is also commonly used with a rising prostate-specific antigen (PSA) level after definitive local treatment.2

Prostate cancer survivors commonly have preexisting CVD and these men are considered to be at significantly higher risk for a CVD event. By collaborating with urology, medical oncology, and the Cardio-Oncology Program, the researchers reported that it was possible to identify which patients were most likely to benefit from ADT.