Approach to Androgen Deprivation in the Prostate Cancer Patient with Pre-existing Cardiovascular Disease
Purpose of Review
Androgen deprivation therapy (ADT) is a mainstay of treatment for advanced prostate cancer. Several studies have reported an association between ADT and an increase in cardiovascular events, especially in those receiving gonadotropin-releasing hormone (GnRH) agonists compared to GnRH antagonists. We review the body of literature reporting the association of ADT and cardiovascular morbidity, and discuss the proposed mechanism of cardiovascular disease due to ADT including metabolic changes that may promote atherosclerosis and local hormonal effects that may increase plaque rupture and thrombosis.
GnRH agonists appear to increase the risk of cardiovascular morbidity by 20–25% in men on these agents compared those who do not receive ADT. GnRH antagonists may appear to have halve this risk while improving PSA progression-free survival.
GnRH antagonists may be superior to GnRH agonists for patients with significant cardiovascular disease, significant metastatic disease burden, or severe lower urinary tract symptoms.
KeywordsAndrogen deprivation Cardiovascular disease Gonadotropin-releasing hormone agonist Gonadotropin-releasing hormone antagonist Degarelix
Compliance with Ethical Standards
Conflict of Interest
Alyssa K. Greiman declares no potential conflicts of interest. Thomas E. Keane reports consultancies for Ferring, Bayer, and Jannsen.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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