Prostate cancer survivors face increased risk of developing heart disease. The three million prostate cancer survivors in the U.S. are more likely to die of another illness. But early detection can prevent early death and improve mortality outcomes. The biggest concern for prostate cancer survivors is heart disease. Researchers have focused on modulating the risk factors for cardiovascular disease in men, especially those receiving androgen deprivation therapy (ADT) to treat prostate cancer, as it has been linked with higher rates of heart disease.
Eric Shinohara, associate professor of Medicine and medical director of the Vanderbilt Radiation Oncology Clinic, said, “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.”
ADT reduces serum testosterone levels, which can make prostate cancer shrink or progress much slower. Previous research has found a link between ADT and heart disease. More specifically, a link has been found between ADT and low-density lipoprotein and triglyceride levels, which increase insulin resistance and create a similar metabolic state seen in metabolic syndrome.
Senior author Javid Moslehi added, “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. In general, cardiovascular wellness is an important aspect of care for all of the nearly 230,000 men newly diagnosed with prostate cancer each year in the U.S.”
In the U.S., cardiovascular disease remains to be the number 1 killer of men, regardless whether they have prostate cancer or not.
Fellow author David Penson added, “Frankly, all men need to be cognizant of the cardiovascular risk. After all, a lot more men die of heart disease than prostate cancer every year in this country. It is particularly important for men on ADT since anything that affects the hormonal balance will impact cardiovascular risk.”
The researchers helped develop the Vanderbilt ABCDE paradigm for cardiovascular health in prostate cancer patients. The ABCDE paradigm refers to Awareness and Aspirin, Blood pressure monitoring, Cholesterol management and Cigarette avoidance, Diet and Diabetes, and Exercise.
Author Alicia Morgans concluded, “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.”
Heart disease: a risk factor for prostate cancer, previous study
Researchers from Duke Cancer Institute found that cardiovascular disease is a potential risk factor for prostate cancer. The findings suggest that the two conditions may share similar underlying causes. The researchers suggest that what’s good for the heart is likewise beneficial for the prostate. Hence, following prevention tips for heart disease may also result in a lower risk of prostate cancer.
The researchers looked at data from 6,390 men who were enrolled in a study known as REDUCE. The participants had a prostate biopsy at two- and four- year marks. The patients also provided detailed medical history, which entailed their weight, incidence of heart disease, alcohol intake, and other risk factors.
Of the participating men, 547 reported pre-enrollment history of coronary artery disease (CAD). Those men tended to be overweight and less healthy, with higher baseline PSA, along with greater rates of diabetes, hypertension, and high cholesterol. These men were also more likely to develop prostate cancer.
Lead author Jean-Alfred Thomas II said, “We controlled for a number of risk factors, including hypertension, taking statins, or aspirin. We don’t have a good grasp on what’s causing the link, but we are observing this association.”