Approach to Androgen Deprivation in the Prostate Cancer Patient with Pre-existing Cardiovascular Disease

• Published in: Current urology reports Vol. 18; no. 6; p. 41
• Main Authors: Greiman, Alyssa K., Keane, Thomas E.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-06-2017
• Subjects: Androgen Antagonists - adverse effects; Androgen Antagonists - therapeutic use; Antineoplastic Agents, Hormonal - adverse effects; Antineoplastic Agents, Hormonal - therapeutic use; Cardiovascular Diseases - chemically induced; Cardiovascular Diseases - metabolism; Gonadotropin-Releasing Hormone - agonists; Gonadotropin-Releasing Hormone - antagonists & inhibitors; Humans; Lower Urinary Tract Symptoms - drug therapy; Male; Medicine; Medicine & Public Health; Nephrology; Prostate Cancer (S Prasad; Prostatic Neoplasms - blood; Prostatic Neoplasms - drug therapy; Risk Factors; Section Editor; Survival Rate; Topical Collection on Prostate Cancer; Urology; Cardiovascular disease; Gonadotropin-releasing hormone antagonist; Androgen deprivation; Gonadotropin-releasing hormone agonist; Degarelix
• ISSN: 1527-2737; 1534-6285
• DOI: 10.1007/s11934-017-0688-5

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.
Recent Findings
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.
Summary
GnRH antagonists may be superior to GnRH agonists for patients with significant cardiovascular disease, significant metastatic disease burden, or severe lower urinary tract symptoms.