The three million prostate cancer survivors in the United States are likely to die from something other than cancer, thanks to early detection, effective treatment and the disease’s slow progression.
What survivors need to be more concerned with is heart disease, the most common non-cancer cause of death for men with prostate cancer, according to a paper published this week in Circulation, authored by Vanderbilt physicians.
For this reason, Vanderbilt’s cardio-oncology program is focusing on modulating the risk factors for cardiovascular disease in men, especially those receiving androgen deprivation therapy (ADT) to treat their prostate cancer.
“While ADT therapy is of great benefit to many patients with prostate cancer, it may also increase the risk of developing diabetes or having a heart attack or stroke. By collaborating with urology, medical oncology and the cardio-oncology program, we are better able to determine which patients are most likely to benefit from hormones, and in those who do get hormones, how to better protect their cardiovascular system,” said Dr. Eric Shinohara, associate professor of medicine and medical director of the Vanderbilt Radiation Oncology Clinic.
ADT reduces serum testosterone levels, which can make prostate cancers shrink or grow more slowly. In 2010 the American Heart Association released a statement about the possible association between ADT and adverse cardiovascular events.
Specifically, there appears to be an association between ADT and increased low-density lipoprotein and triglyceride levels, increased fat and decreased lean body mass, increased insulin resistance and decreased glucose tolerance, and a general metabolic state similar to metabolic syndrome, according to the Circulation paper.
“Aggressive treatment of these altered cardiovascular risk factors can be an important step to decrease the risk of heart attack and stroke in patients treated with ADT,” said senior author Dr. Javid Moslehi, assistant professor of medicine and director of Vanderbilt’s cardio-oncology program.
Vanderbilt’s cardio-oncology program is rare in its collaborative, multi-specialty care of men with prostate cancer, said Dr. Moslehi, who helped develop the Vanderbilt ABCDE paradigm for cardiovascular health in cancer survivors, an algorithm that is now being adapted as part of national cancer survivorship guidelines by National Comprehensive Cancer Network (NCCN).
The ABCDE algorithm for prostate cancer survivors includes awareness and aspirin; blood pressure monitoring; cholesterol management and cigarette avoidance; diet and diabetes; and exercise. Patient education is a shared responsibility of the multiple specialists who comprise the cardio-oncology program.