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Integrating cardio-oncology in prostate cancer care: Addressing cardiovascular risks in cancer survivors

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Dr Alexander Lyon
Dr Alexander Lyon

In recent years, we have seen a significant transformation in cancer treatment outcomes. This progress has led to the development of a new field: Cardio-oncology. Cardio-oncology focuses on optimising cardiovascular (CV) health in cancer patients before, during, and after their cancer therapy. This approach is essential because many cancer treatments can have adverse effects (AEs) on the CV system, requiring integrated care between oncologists and cardiologists. 

The importance of cardio-oncology becomes evident when considering the survival rates of prostate cancer (PCa) patients. Many men no longer die from PCa but live with it as a controlled, chronic disease. However, some men living with PCa may develop CV diseases, often exacerbated by cancer treatments as mentioned.  

Studies have shown that men living with PCa - especially those undergoing androgen deprivation therapy (ADT) - face an increased risk of CVDs, including myocardial infarction (MI), heart failure (HF), and stroke. This risk is particularly pronounced in men with pre-existing CV conditions. 

A Swedish study involving 76 000 participants living with PCa, showed that men treated with ADT had a 40% higher risk of CVD than those not on such therapy. This risk translates into an increased incidence of MI, arrhythmias, ischaemic heart disease, HF, and stroke. The study emphasised that ADT therapy accelerates CV risks through mechanisms such as increased diabetes incidence, hypertension, and prothrombotic effects. 

One potential solution to mitigate these CV risks is to consider the type of ADT used. Research has suggested that gonadotropin hormone-releasing hormone (GnRH) antagonists may present a lower CV risk compared to GnRH agonists. 

GnRH agonists are known to cause significant metabolic changes. These changes include muscle mass loss, increased abdominal adiposity, and a rise in cholesterol levels, which can contribute to new-onset diabetes and increased CV risk.  

 The Oral relugolix for Androgen-Deprivation Therapy in Advanced Prostate Cancer study showed that relugolix, a GnRH antagonist, not only maintained effective testosterone suppression but also significantly reduced major adverse cardiac events compared to GnRH agonists. 

In response to these findings, the European Society of Cardiology (ESC) has developed guidelines for cardio-oncology, emphasising the need for CV risk assessments before starting cancer treatment. These guidelines recommend using 10-year CV risk scores and regular monitoring of CV health during treatment. For high-risk patients, GnRH antagonists may be preferable, and ongoing assessments of blood pressure (BP), cholesterol, and glucose levels are essential. 

Primary care physicians and cardiologists play a crucial role in managing the CV health of patients living with PCa. They should educate patients on healthy lifestyles, monitor BP and cholesterol levels, and manage diabetes and hypertension effectively. The integration of cardio-oncology into routine cancer care ensures that patients receive comprehensive treatment that addresses their cancer and CV health, improving overall survival and quality of life. 

If you missed the webinar, you can access the replay video here. Once you have finished watching the webinar, send an e-mail to john.woodford@newmedia.co.za to have your CPD point allocated.  

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