Internists should follow up with prostate cancer patients receiving ADT
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Studies that suggest a possible association between androgen-deprivation therapy (ADT) and an increased risk of cardiovascular events, including myocardial infarction and cardiovascular mortality, may be driving more consultations between patients, internists, endocrinologists and cardiologists.
To inform these consultations, a multispecialty group assembled a science advisory, a strictly informative paper that should not dictate clinical practice or supersede the clinical judgment of a physician. The paper was published online in the Feb. 1 Circulation.
ADT is widely used for prostate cancer. It's a mainstay for overt metastatic disease, and the standard of care for high-risk prostate cancer when combined with external-beam radiation therapy. ADT is also often used for prostate volume reduction in men before definitive local therapy with brachytherapy, or to treat rising prostate-specific antigen levels after definitive local treatment.
Observed cardiovascular effects noted in the literature include: decreased lean body mass and increased fat mass, increased serum cholesterol and triglyceride levels, and increased fasting plasma insulin levels, a marker of insulin resistance in men with prostate cancer.
The advisory states that patients do not need to be referred to internists, endocrinologists or cardiologists for evaluation before starting ADT. They should see their primary care physician within three to six months after starting ADT to assess blood pressure, lipid profile and glucose level. However, no data guide further follow-up intervals.
The physician treating the patient for prostate cancer should decide whether to start ADT in patients with cardiac disease, and should weigh benefits against potential risks, specifically for patients with known coronary artery disease.
Cardiologists in particular should not feel compelled to perform any specific testing or coronary intervention before starting ADT. No data suggest that stress testing can predict potential future cardiac risks, or that revascularization before ADT would decrease future cardiovascular risk, the advisory says.