Prostate cancer (PCa) is the most common cancer among men. Advances in early detection and successful treatments have improved cancer-specific survival. With prolonged survival, PCa patients now suffer from the effects of aging and are at increasing risk for the development of cardiovascular (CV) risk factors and CV disease. Androgen deprivation therapy (ADT) is the mainstay treatment of advanced PCa. There is conflicting evidence about whether or not ADT is associated with increased CV morbidity and mortality. Metabolic abnormalities such as increasing body weight, reduced insulin sensitivity, dyslipidemia, and activation of T cells to the Th1 phenotype, resulting in atherosclerotic plaque destabilization, have been proposed as possible mechanisms by which ADT may increase the risk of CV events. Type of ADT and preexisting CV history also seem to play a major role in the risk of subsequent CV events. Ongoing prospective clinical trials will help define whether there is any difference between gonadotropin-releasing hormone agonists and antagonists in terms of CV morbidity and mortality.