Recent research led by physicians at Vanderbilt University Medical Center focused on the risk factors for cardiovascular disease in prostate cancer survivors, as this is the most common non-cancer cause of fatality among men with prostate cancer. Researchers reported that 3 million prostate cancer survivors in the United States will most likely die from other causes rather than cancer. This is thought to be due to early cancer detection, effective treatment, and slow progression.
The article, “Cardiovascular Effects of Androgen Deprivation Therapy for the Treatment of Prostate Cancer,” was published in the journal Circulation.
Cardiovascular disease ranks No. 1 among the most deadly diseases for men in the United States, whether they have prostate cancer or not. Dr. David Penson, co-author of the study, believes men are not sufficiently aware of the elevated risk associated with androgen deprivation therapy (ADT), a treatment in which androgen levels (the male hormones) are reduced.
“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,” Penson said in a press release.
Vanderbilt’s cardio-oncology program is now focusing on modulating the cardiovascular disease risk factors in men, particularly in those receiving ADT to treat their prostate cancer, since this therapy has been linked to diabetes, heart attack, and stroke despite its benefits.
“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,” said Eric Shinohara, MD, MSCI, Vanderbilt’s associate professor of medicine and medical director of its Radiation Oncology Clinic.
The way ADT works is by reducing serum testosterone levels, thus making prostate cancers shrink or slow down their growth. But already in 2010, the American Heart Association released a warning about the possible connection between ADT and adverse cardiovascular effects, as ADT seems to be associated with an increased low-density lipoprotein and triglyceride levels, increased fat, and decreased lean body mass, besides an increased resistance to insulin and lowered glucose tolerance.
“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,” said Javid Moslehi, MD, assistant professor of medicine and senior author who is also directing Vanderbilt’s cardio-oncology program. Patients who undergo ADT sometimes reach a general metabolic state that is very similar to that of metabolic syndrome.
“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.,” Moslehi said.
“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,” said oncologist Alicia Morgans, MD, MPH, assistant professor of medicine and study’s co-author.
Patient education is a shared responsibility of the multiple specialists who comprise the Vanderbilt’s cardio-oncology program. The program is a collaborative, multi-specialty care for prostate cancer patients, according to Moslehi, who was also responsible for developing the Vanderbilt ABCDE paradigm for cardiovascular health in cancer survivors. The ABCDE algorithm for prostate cancer survivors includes awareness and aspirin, blood pressure monitoring, cholesterol management, and cigarette avoidance, diet, diabetes, and exercise.
The National Comprehensive Cancer Network (NCCN) didn’t let the algorithm go unnoticed and has already begun the process of adapting it to become part of its national cancer survivorship guidelines.