Treating prostate cancer often requires navigating tough decisions, especially when it comes to the use of testosterone-blocking drugs. These drugs, which play a key role in slowing the growth of prostate cancer, come with important trade-offs, particularly concerning heart health.
Testosterone fuels the growth of prostate cancer, which is why many treatments aim to block or reduce its production. One common approach is androgen deprivation therapy (ADT), which works by suppressing the body’s testosterone production. Another, more recent class of drugs known as androgen-receptor signaling inhibitors (ARSIs), targets the hormone by blocking its ability to bind to its cell receptor, effectively neutralizing its growth-promoting effects.
When used in combination, ADT and ARSIs have proven to significantly improve survival rates for men with advanced prostate cancer. This potent treatment combination, known as intensified ADT, is also being explored for use in treating men with early-stage prostate cancer. However, despite its effectiveness, these treatments come with a number of side effects one of the most concerning being the increased risk of cardiovascular disease.
A recent study led by British researchers has highlighted that when ADT and ARSIs are used together, they can significantly heighten the risk of heart problems. The researchers examined 24 clinical trials conducted between 2012 and 2024, involving over 22,000 men aged 63 to 77. These men were diagnosed with various stages of prostate cancer, ranging from early, aggressive forms to advanced, metastatic cancer that no longer responded to ADT alone.
The primary aim of the study was to evaluate the heart-related risks associated with these treatments, including high blood pressure, abnormal heart rhythms, blood clots, and even life-threatening events such as heart attacks and strokes. The findings were striking: combining ADT with ARSIs roughly doubled the likelihood of cardiovascular complications across all stages of prostate cancer. More severe heart events that required hospitalization occurred in about 7.8% to 15.6% of cases, depending on the treatment regimen.
Of particular concern was the combination of two ARSIs abiraterone acetate and enzalutamide which increased the risk of cardiac events by as much as four times. This combination has raised alarms, with experts advising against its use, as it appears to worsen side effects without providing additional benefits in terms of cancer survival.
Men with pre-existing heart conditions face even greater risks, as the intensified therapy can exacerbate underlying cardiovascular issues. Dr. Katelyn Atkins, a radiation oncologist at Cedars-Sinai Medical Center in Los Angeles, pointed out that heart disease is the second leading cause of death among men with prostate cancer. She emphasizes the importance of screening for heart disease before starting treatment and suggests that patients with early signs of atherosclerosis, or fatty buildup in the arteries, should receive particular attention.
Fortunately, cardiovascular risks can be mitigated through lifestyle changes, such as regular exercise, a heart-healthy diet, and, if necessary, the use of statins to lower cholesterol. For those receiving intensified ADT, it is essential that heart health be closely monitored both before and after treatment.
Experts, including Dr. David Crawford, a urologic oncology specialist at the University of Colorado Anschutz Medical Campus, argue that while intensified therapy can prolong survival and even cure some cases of prostate cancer, it is crucial to balance the benefits against the potential heart risks. Combining treatments effectively is key to optimizing outcomes for patients, but managing the cardiovascular side effects is equally important to ensure that the treatment doesn’t inadvertently harm the patient’s overall health.
As research continues to evolve, it is clear that while testosterone-blocking drugs can significantly improve cancer survival, careful consideration and management of their side effects are crucial to protect heart health in the long term.
