Cardiovascular Risks of Androgen Deprivation Therapy for Prostate Cancer.
Giovanni CoronaSandra FilippiNicola BianchiMauro DicuioGiulia RastrelliSergio ConcettiAlessandra SforzaMario MaggiPublished in: The world journal of men's health (2020)
Androgen deprivation therapy (ADT) is the gold standard treatment in patients with locally advanced or metastatic prostate cancer (PC). Emerging evidence has documented a tight association between ADT and body composition, along with metabolic profile impairment. These alterations might underpin the observed ADT-related increase in cardiovascular (CV) and thromboembolic (venous thromboembolism, VTE) mortality and morbidity. However, the specific mechanisms underlying these associations have not yet been completely elucidated. In the present review we summarize and discussed the available evidence linking ADT to increased cardio-metabolic risk, using both preclinical and clinical data. When possible, meta-analytic studies were preferred. Preclinical evidence, using a rabbit model of gonadotrophin-releasing hormone analogue-induced hypogonadism, indicates that the induced condition is associated with a dramatic increase in visceral adiposity and with an impairment of acetylcholine induced vascular relaxation, along with an increased propensity towards fatty liver. This suggests a direct role of ADT in inducing a worsened metabolic profile. In contrast, available clinical data are not sufficient to clarify a direct pathogeniclink between reduced testosterone (T) and altered metabolism. In fact, although T deprivation is associated with an altered metabolism, it is possible that the association between ADT and CV or VTE risk could simply be the result of a selection bias, related to the poor health status of patients with advanced PC. Despite the aforementioned considerations, all patients who are candidatesfor ADT should be screened for CV risk factors at baseline and monitored during the therapy. Life-style modifications and physical exercise are strongly encouraged.
Keyphrases
- venous thromboembolism
- prostate cancer
- body composition
- risk factors
- high glucose
- diabetic rats
- squamous cell carcinoma
- drug induced
- replacement therapy
- insulin resistance
- small cell lung cancer
- locally advanced
- end stage renal disease
- radical prostatectomy
- resistance training
- cell therapy
- direct oral anticoagulants
- atrial fibrillation
- clinical trial
- radiation therapy
- newly diagnosed
- cardiovascular disease
- metabolic syndrome
- ejection fraction
- stem cells
- coronary artery disease
- lymph node
- risk assessment
- computed tomography
- deep learning
- study protocol
- patient reported outcomes
- body mass index
- weight gain
- climate change
- bone marrow
- stress induced
- human health