Assessing the cardiovascular risk of hormonal therapy in patients with prostate cancer

Androgen deprivation therapy (ADT) which remains the first line of therapy for patients with metastatic prostate cancer (PCa) has been associated with metabolic abnormalities and significant risk of cardiovascular disease (CVD) (1). Based on observational studies and two meta-analyses, ADT increases the risk for cardiovascular events but results from randomized clinical trials and relevant subsequent meta-analyses did not confirm those conclusions (1). This literature discrepancy in cardiovascular outcomes in patients on ADT may be associated with lack of evaluation of different types of ADT including gonadotropin-releasing hormone (GnRH) agonists, orchiectomy or anti-androgens, absence of comparison to age-matched patients without PCa, and not assessing pre-existing CVD as a confounding factor.