Prostate cancer is the most common malignancy in men, mostly affecting older men who harbor an increased prevalence of cardiovascular disease and metabolic syndrome. Androgen deprivation therapy (ADT), the standard therapy for various stages of prostate cancer, further increases the risk for cardiovascular disease and for metabolic syndrome. Therefore, screening for cardiovascular risk factors should be performed prior to the initiation of ADT, and, if necessary, cardiological evaluation and interdisciplinary management should be provided during and after completion of ADT. Moreover, the use of a gonadotropin-releasing hormone (GnRH) antagonist may help reduce cardiovascular risk in patients with cardiovascular disease.

Das Prostatakarzinom ist die häufigste Tumorerkrankung bei Männern. Es sind insbesondere Männer im fortgeschrittenen Alter mit einer erhöhten Prävalenz für das metabolische Syndrom und kardiovaskuläre Erkrankungen betroffen. Die Androgendeprivationstherapie (ADT) ist seit Jahrzehnten die Standardtherapie in verschiedenen Prostatakarzinomstadien und erhöht zusätzlich das Risiko für kardiovaskuläre Erkrankungen und für das metabolische Syndrom. Aus diesen Gründen sollte vor der Initiierung einer ADT ein Screening auf das Vorhandensein von kardiovaskulären Risikofaktoren sowie ggf. eine kardiologische Vorstellung und Mitbetreuung während und nach Abschluss der ADT erfolgen. Darüber hinaus kann bei Patienten mit kardiovaskulären Vorerkrankungen der Einsatz eines GnRH-Antagonisten („gonadotropin-releasing hormone“) helfen, das kardiovaskuläre Risiko zu reduzieren.

2 Univeristätsklinik für Innere Medizin Klinik für Kardiologie Medizinische Universität Wien Wien Österreich

Hourani Zentrum für Wissenschaft Al Ahliyya Amman Universität Amman Jordanien

Karl Landsteiner Institut für Urologie und Andrologie Wien Österreich

Klinik für Hämatologie und Onkologie Universitätsklinikum Hamburg Eppendorf Hamburg Deutschland

Klinik für Urologie 2 Medizinische Fakultät Charles Universität Prag Tschechien

Klinik für Urologie Comprehensive Cancer Center Medizinische Universität Wien Wien Österreich

Klinik für Urologie Martini Klinik Prostatakarzinom Zentrum Universitätsklinikum Hamburg Eppendorf Hamburg Deutschland

Klinik für Urologie Texas Southwestern Universität Dallas TX USA

Klinik für Urologie Universitätsklinikum Hamburg Eppendorf Martinistr 52 20246 Hamburg Deutschland

Klinik für Urologie Universitätsklinikum Koc Istanbul Türkei

Klinik für Urologie Weill Cornell Medical College New York NY USA

See more in PubMed

Sung H, Ferlay J, Siegel RL et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71:209–249 PubMed DOI

Siegel RL, Miller KD, Fuchs HE et al (2022) Cancer statistics, 2022. CA Cancer J Clin 72:7–33 PubMed DOI

Studer UE, Whelan P, Albrecht W et al (2006) Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer (EORTC) Trial 30891. J Clin Oncol 24:1868–1876 PubMed DOI

Elmehrath AO, Afifi AM, Al-Husseini MJ et al (2021) Causes of death among patients with metastatic prostate cancer in the US from 2000 to 2016. Jama Netw Open 4:e2119568 PubMed DOI PMC

Kokorovic A, So AI, Serag H et al (2022) UPDATE—Canadian urological association guideline on androgen deprivation therapy: adverse events and management strategies summary of changes. Can Urol Assoc J 16:243–244 PubMed DOI PMC

Cornford P, Van Den Bergh RCN, Briers E et al (2021) EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer. Part II-2020 update: treatment of relapsing and metastatic prostate cancer. Eur Urol 79:263–282 PubMed DOI

Oefelein MG, Feng A, Scolieri MJ et al (2000) Reassessment of the definition of castrate levels of testosterone: implications for clinical decision making. Urology 56:1021–1024 PubMed DOI

Seidenfeld J, Samson DJ, Hasselblad V et al (2000) Single-therapy androgen suppression in men with advanced prostate cancer: a systematic review and meta-analysis. Ann Intern Med 132:566–577 PubMed DOI

Mottet N, Van Den Bergh RCN, Briers E et al (2021) EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate cancer-2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 79:243–262 PubMed DOI

Riaz IB, Naqvi Sa A, He H et al (2023) First-line systemic treatment options for metastatic castration-sensitive prostate cancer: a living systematic review and network meta-analysis, JAMA Oncol. Aufl.

Saigal CS, Gore JL, Krupski TL et al (2007) Androgen deprivation therapy increases cardiovascular morbidity in men with prostate cancer. Cancer 110:1493–1500 PubMed DOI

Liang Z, Zhu J, Chen L et al (2020) Is androgen deprivation therapy for prostate cancer associated with cardiovascular disease? A meta-analysis and systematic review. Andrology 8:559–574 PubMed DOI

Khoshkar Y, Vigneswaran HT, Eloranta S et al (2022) Cardiovascular, bone, and metabolic health in men with castrate-resistant prostate cancer treated with androgen deprivation: a matched cohort study. Acta Oncol 61:1377–1385 PubMed DOI

Kulkarni AA, Rubin N, Tholkes A et al (2021) Risk for stroke and myocardial infarction with abiraterone versus enzalutamide in metastatic prostate cancer patients. Esmo Open 6:100261 PubMed DOI PMC

Iacovelli R, Ciccarese C, Bria E et al (2018) The cardiovascular toxicity of Abiraterone and Enzalutamide in prostate cancer. Clin Genitourin Cancer 16:e645–e653 PubMed DOI

Armstrong AJ, Lin P, Tombal B et al (2020) Five-year survival prediction and safety outcomes with Enzalutamide in men with chemotherapy-naïve metastatic castration-resistant prostate cancer from the PREVAIL trial. Eur Urol 78:347–357 PubMed DOI

O’farrell S, Garmo H, Holmberg L et al (2015) Risk and timing of cardiovascular disease after androgen-deprivation therapy in men with prostate cancer. J Clin Oncol 33:1243–1251 PubMed DOI

Anonymous (2020) Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet 396:1204–1222 DOI

Albertsen PC, Klotz L, Tombal B et al (2014) Cardiovascular morbidity associated with gonadotropin releasing hormone agonists and an antagonist. Eur Urol 65:565–573 PubMed DOI

Cirne F, Aghel N, Petropoulos JA et al (2022) The cardiovascular effects of gonadotropin-releasing hormone antagonists in men with prostate cancer. Eur Heart J Cardiovasc Pharmacother 8:253–262 PubMed DOI

Abufaraj M, Iwata T, Kimura S et al (2021) Differential impact of gonadotropin-releasing hormone antagonist versus agonist on clinical safety and oncologic outcomes on patients with metastatic prostate cancer: a meta-analysis of randomized controlled trials. Eur Urol 79:44–53 PubMed DOI

Von Amsberg G, Thiele H, Merseburger A (2021) Cardiovascular side effects in patients undergoing androgen deprivation therapy: superiority of gonadotropin-releasing hormone antagonists? An update. Urol Ausg A 60:1450–1457

Merseburger AS, Sedding D, Hüter K (2016) Cardiovascular risk patients under androgen deprivation therapy: lower risk with GnRH antagonists compared to LHRH agonists? Urol Ausg A 55:218–225 DOI

Margel D, Peer A, Ber Y et al (2019) Cardiovascular morbidity in a randomized trial comparing GnRH agonist and GnRH antagonist among patients with advanced prostate cancer and preexisting cardiovascular disease. J Urol 202:1199–1208 PubMed DOI

Shore ND, Saad F, Cookson MS et al (2020) Oral Relugolix for androgen-deprivation therapy in advanced prostate cancer. N Engl J Med 382:2187–2196 PubMed DOI

Hopmans SN, Duivenvoorden WCM, Werstuck GH et al (2014) GnRH antagonist associates with less adiposity and reduced characteristics of metabolic syndrome and atherosclerosis compared with orchiectomy and GnRH agonist in a preclinical mouse model1Contributed equally and share first authorship. Urol Oncol Seminars Orig Investig 32:1126–1134

Lopes RD, Higano CS, Slovin SF et al (2021) Cardiovascular safety of Degarelix versus Leuprolide in patients with prostate cancer: the primary results of the PRONOUNCE randomized trial. Circulation 144:1295–1307 PubMed DOI PMC

Ng CF, Teoh JYC, Chiu PKF (2022) Letter by Ng et al regarding article, “cardiovascular safety of Degarelix versus Leuprolide in patients with prostate cancer: the primary results of the PRONOUNCE randomized trial”. Circulation 145:e773–e774 PubMed DOI

Wallach JD, Deng Y, Mccoy RG et al (2021) Real-world cardiovascular outcomes associated with Degarelix vs Leuprolide for prostate cancer treatment. Jama Netw Open 4:e2130587 PubMed DOI PMC

George G, Garmo H, Scailteux LM et al (2021) Risk of cardiovascular disease following gonadotropin-releasing hormone agonists vs antagonists in prostate cancer: Real-world evidence from five databases. Int J Cancer 148:2203–2211 PubMed DOI

Zengerling F, Jakob JJ, Schmidt S et al (2021) Degarelix for treating advanced hormone-sensitive prostate cancer. Cochrane Database Syst Rev 8:Cd12548 PubMed

Lyon AR, López-Fernández T, Couch LS et al (2022) 2022 ESC guidelines on cardio-oncology developed in collaboration with the European hematology association (EHA), the European society for therapeutic radiology and oncology (ESTRO) and the international Cardio-oncology society (IC-OS): developed by the task force on cardio-oncology of the European society of cardiology (ESC). Eur Heart J 43:4229–4361 PubMed DOI

Timmis A, Vardas P, Townsend N et al (2022) European society of cardiology: cardiovascular disease statistics 2021. Eur Heart J 43:716–799 PubMed DOI

Kassi E, Pervanidou P, Kaltsas G et al (2011) Metabolic syndrome: definitions and controversies. BMC Med 9:48 PubMed DOI PMC

Belladelli F, Montorsi F, Martini A (2022) Metabolic syndrome, obesity and cancer risk. Curr Opin Urol 32:594–597 PubMed DOI

Bosco C, Crawley D, Adolfsson J et al (2015) Quantifying the evidence for the risk of metabolic syndrome and its components following androgen deprivation therapy for prostate cancer: a meta-analysis. PLoS ONE 10:e117344 PubMed DOI PMC

Morote J, Gómez-Caamaño A, Alvarez-Ossorio JL et al (2015) The metabolic syndrome and its components in patients with prostate cancer on androgen deprivation therapy. J Urol 193:1963–1969 PubMed DOI

Gacci M, Russo GI, De Nunzio C et al (2017) Meta-analysis of metabolic syndrome and prostate cancer. Prostate Cancer Prostatic Dis 20:146–155 PubMed DOI

Levine GN, D’amico AV, Berger P et al (2010) Androgen-deprivation therapy in prostate cancer and cardiovascular risk: a science advisory from the American heart association, American cancer society, and American urological association: endorsed by the American society for radiation oncology. CA Cancer J Clin 60:194–201 PubMed DOI PMC

Kenk M, Grégoire JC, Coté MA et al (2020) Optimizing screening and management of cardiovascular health in prostate cancer: A review. Can Urol Assoc J 14:E458–e464 PubMed DOI PMC

Roth GA, Mensah GA, Johnson CO et al (2020) Global burden of cardiovascular diseases and risk factors, 1990–2019: update from the GBD 2019 study. J Am Coll Cardiol 76:2982–3021 PubMed DOI PMC

Tombal B (2009) A holistic approach to androgen deprivation therapy: treating the cancer without hurting the patient. Urol Int 83:373–378 PubMed DOI

Curigliano G, Lenihan D, Fradley M et al (2020) Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. Ann Oncol 31:171–190 PubMed DOI