Northwestern University Feinberg School of Medicine, Chicago, IL.
Carolina Urologic Research Center, 823 82nd Pkwy Suite B, Myrtle Beach, SC 29572.
Urol Oncol. 2021 Jan;39(1):52-62. doi: 10.1016/j.urolonc.2020.08.003. Epub 2020 Sep 18.
Prostate cancer and cardiovascular (CV) disease share several risk factors, with the incidence of both rising with increasing age. Systemic prostate cancer therapies may increase CV risk. For example, gonadotropic releasing hormone agonists have been associated with increased development of CV risk factors, and potentially with CV disease. For men with non-metastatic castration-resistant prostate cancer (nmCRPC), the opportunity to mitigate CV risk by appropriate selection of therapy (i.e., use of newer agents such as androgen receptor inhibitors) may be possible. The phase 3 PROSPER, SPARTAN, and ARAMIS trials for enzalutamide, apalutamide, and darolutamide, the 3 approved androgen receptor inhibitors for men with nmCRPC, were all associated with increased metastasis-free survival in patients with metastatic castration-resistant prostate cancer (mCRPC). Our objective in writing this review is to improve awareness of the relationship between long-term androgen deprivation and increased risk for CV disease and inform treatment decision making for patients with mCRPC who also have CV comorbidities.
The PubMed database was searched from 2010 to November 5, 2019 for articles pertaining to androgen receptor inhibitors, androgen inhibition, apalutamide, darolutamide, enzalutamide, CV, and CaP.
We found literature describing the relationship between androgen inhibition and CV disease and risks. Given the increased risk of CV disease due to exposure to gonadotropic releasing hormone agonist therapy alone, understanding the potential for additional CV risks is important for patients with CV comorbidities when an androgen receptor inhibitor is added to their treatment. Another important consideration is the possibility of drug-drug interactions with comedications.
Management strategies for patients with mCRPC also treated for comorbidities including CV disease require appropriate selection of therapy, diet, and exercise to meet the needs of the individual patient profile.
前列腺癌和心血管（CV）疾病有一些共同的风险因素，两者的发病率都随着年龄的增长而上升。全身前列腺癌治疗可能会增加 CV 风险。例如，促性腺激素释放激素激动剂与 CV 危险因素的增加有关，并且可能与 CV 疾病有关。对于患有非转移性去势抵抗性前列腺癌（nmCRPC）的男性，通过适当选择治疗方法（即使用新型药物，如雄激素受体抑制剂）来降低 CV 风险的机会是可能的。对于患有转移性去势抵抗性前列腺癌（mCRPC）的患者，三期 PROSPER、SPARTAN 和 ARAMIS 试验均表明恩扎鲁胺、阿帕鲁胺和达罗鲁胺（用于治疗 nmCRPC 的 3 种批准的雄激素受体抑制剂）可延长无转移生存期。我们撰写这篇综述的目的是提高对长期雄激素剥夺与 CV 疾病风险增加之间关系的认识，并为同时患有 CV 合并症的 mCRPC 患者的治疗决策提供信息。
从 2010 年至 2019 年 11 月 5 日，我们在 PubMed 数据库中搜索了与雄激素受体抑制剂、雄激素抑制、阿帕鲁胺、达罗鲁胺、恩扎鲁胺、CV 和 CaP 相关的文章。
我们发现了描述雄激素抑制与 CV 疾病和风险之间关系的文献。由于单独使用促性腺激素释放激素激动剂治疗会增加 CV 疾病的风险，因此对于患有 CV 合并症的患者，当在其治疗中添加雄激素受体抑制剂时，了解潜在的额外 CV 风险非常重要。另一个重要的考虑因素是与合并用药的药物-药物相互作用的可能性。
对于患有 mCRPC 且同时患有合并症（包括 CV 疾病）的患者，其管理策略需要适当选择治疗方法、饮食和运动，以满足个体患者的需求。
