Prostate cancer and heart disease are two of the most common serious health concerns for men globally. The link between them is intricate, involving overlapping risk factors and, more significantly, cardiovascular side effects stemming from prostate cancer treatments. Understanding this connection is paramount because cardiovascular disease is now recognized as the leading cause of non-cancer death among prostate cancer survivors.
Shared Risk Factors: The Common Ground
The association between prostate cancer and heart disease largely stems from shared pre-existing health conditions. Both conditions often affect men in the same age brackets, and many of the same lifestyle and metabolic factors increase the likelihood of developing either. The collective presence of conditions like high blood pressure, elevated cholesterol levels, and diabetes—often grouped under the term metabolic syndrome—creates an environment for both cancer progression and cardiovascular disease.
High plasma cholesterol levels, for instance, have been reported to increase the risk for both coronary artery disease and prostate cancer. One analysis of a large drug trial indicated that men with coronary artery disease had a 35 percent greater risk of developing prostate cancer over time compared to men without heart disease. This suggests a deeper, possibly molecular, connection where the processes that promote vascular damage may also contribute to the development of the malignancy.
Androgens, or male hormones, are another biological factor linking the two conditions. Naturally low testosterone in men is associated with adverse cardio-metabolic factors, including increased inflammation, insulin resistance, and dyslipidemia. Higher endogenous testosterone levels are associated with a reduced risk of cardiovascular disease and related mortality. These shared risk factors highlight that managing blood pressure and cholesterol, which is beneficial for the heart, is also likely beneficial for the prostate.
Androgen Deprivation Therapy (ADT) and Heart Risk
The most substantial link between prostate cancer and cardiovascular risk arises from a common treatment known as Androgen Deprivation Therapy (ADT). This hormonal therapy is standard for locally advanced and metastatic prostate cancer because cancer cells rely on androgens for growth. ADT works by reducing the body’s androgen levels, either through medication or surgical removal of the testes, but this hormone suppression carries significant cardiovascular consequences.
The reduction of androgen levels through ADT can induce metabolic changes that closely resemble metabolic syndrome. The therapy is known to lower insulin sensitivity and cause dyslipidemia. These metabolic shifts accelerate the process of atherosclerosis, where plaque builds up in the arteries, greatly increasing the risk of coronary artery disease. Observational studies have consistently demonstrated an increased rate of cardiovascular events in patients undergoing ADT.
The rise in adverse cardiovascular events is attributed to ADT’s tendency to increase total body fat and decrease lean muscle mass. This change in body composition, known as sarcopenic obesity, further contributes to an atherogenic risk profile. The increased risk of cardiovascular events seems to occur regardless of whether the patient receives short- or long-term ADT. These metabolic changes increase the predisposition to acute cardiac problems, especially in men with underlying heart issues.
Specific Cardiovascular Complications of Treatment
The types of cardiovascular complications associated with ADT are varied and can be life-threatening. They include a heightened risk of myocardial infarction and cerebrovascular accidents. Observational data has also indicated an increased risk of sudden cardiac death in men treated with certain types of ADT.
The specific type of ADT used can influence the level of cardiovascular risk, a distinction that has become increasingly relevant in clinical practice. Gonadotropin-releasing hormone (GnRH) agonists, a common form of ADT, have been linked to an increased risk of incident diabetes mellitus, heart attack, and sudden cardiac death. However, a different class of drugs, GnRH antagonists, may pose a lower cardiovascular risk, particularly for men with a history of pre-existing cardiovascular disease.
Newer hormonal agents used in prostate cancer treatment also carry specific cardiac risks. The CYP17 inhibitor abiraterone, which blocks androgen production outside the testes, has been shown in meta-analyses to increase the risk of cardiac events. These differences in risk profiles mean that the choice of prostate cancer therapy should be highly individualized, taking the patient’s heart health history into careful consideration.
The Importance of Cardio-Oncology
Since cardiovascular disease is the leading non-cancer cause of death in prostate cancer survivors, a collaborative approach to patient care is necessary. This integrated strategy is often referred to as cardio-oncology, focusing on the prevention, early detection, and management of heart disease in cancer patients.
Before initiating ADT, a comprehensive assessment of the patient’s cardiovascular risk profile is highly recommended. This includes screening for and optimizing modifiable risk factors like hypertension, high cholesterol, and elevated blood sugar levels. For patients with established heart disease, the risk of cardiovascular events is especially high during the initial six months of ADT.
Regular monitoring of blood sugar, blood pressure, and lipid panels is standard care for men receiving ADT. Non-diabetic patients on ADT face an almost 60 percent increased risk of developing diabetes mellitus, necessitating close surveillance of glucose levels. By adopting a multidisciplinary team-based approach, involving oncologists, cardiologists, and primary care physicians, it is possible to mitigate the cardiovascular morbidity and mortality risk for prostate cancer patients undergoing treatment.