Hassan Mona Ali, Telvizian Talar, Abohelwa Mostafa, Mukherji Deborah, Skouri Hadi
Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon.
Department of Internal Medicine, Lankenau Medical Center, Wynnewood, PA 19096, USA.
Ecancermedicalscience. 2022 Sep 14;16:1445. doi: 10.3332/ecancer.2022.1445. eCollection 2022.
Androgen deprivation therapy (ADT) is the mainstay of treatment for advanced prostate cancer, improving symptoms and prolonging survival. There is an association between ADT use and cardiovascular (CV) events, particularly in patients with preexisting risk factors. In men diagnosed with prostate cancer, CV disease is the principal non-cancer-related cause of death. There are no definite guidelines to stratify patients based on CV risk prior to ADT initiation. This is the first study on cardiac risks and events in patients with prostate cancer treated with ADT from the Middle East region, a population known to have a high prevalence of CV risk factors.
A retrospective study of 234 patients with prostate cancer, who received ADT therapy at a tertiary care centre in Lebanon was conducted. CV risk factors at baseline and CV events on ADT were reviewed. The median age was 68 years (48-92 years). The majority of patients had stage 4 diseases at diagnosis (49.6%) with a median duration of 12 months on ADT. In our cohort, 24.4% had body mass index > 30, 52.1% had smoking history, 25.6% were diabetic, 19.7% had history of coronary artery disease, 9.8% had heart failure history and 52.9% had hypertension. Less than half of the patients had a documented lipid profile at baseline. Twenty-two patients (9.5%) had documented cardiac events following ADT initiation.
In this cohort of patients from the Middle East, we found that one third of the population had established coronary artery disease at baseline and 9.5% had documented cardiac events on ADT initiation. Our study highlights the gaps in CV risk assessment for this high-risk group of patients with prostate cancer in addition to high prevalence of CV comorbidities. Risk and resource-stratified algorithms are needed before starting ADT therapy for optimal CV health. Increased awareness, collaboration and referral mechanisms between oncologists, urologists and cardiologists are also needed to provide optimal care.
雄激素剥夺疗法（ADT）是晚期前列腺癌治疗的主要手段，可改善症状并延长生存期。ADT的使用与心血管（CV）事件之间存在关联，尤其是在已有风险因素的患者中。在被诊断为前列腺癌的男性中，心血管疾病是主要的非癌症相关死亡原因。在开始ADT之前，尚无明确的指南依据心血管风险对患者进行分层。这是中东地区第一项关于接受ADT治疗的前列腺癌患者心脏风险和事件的研究，该地区人群已知具有较高的心血管风险因素患病率。
对在黎巴嫩一家三级医疗中心接受ADT治疗的234例前列腺癌患者进行了一项回顾性研究。回顾了基线时的心血管风险因素和ADT期间的心血管事件。中位年龄为68岁（48 - 92岁）。大多数患者在诊断时为4期疾病（49.6%），ADT的中位持续时间为12个月。在我们的队列中，24.4%的人体质量指数> 30，52.1%有吸烟史，25.6%患有糖尿病，19.7%有冠状动脉疾病史，9.8%有心力衰竭史，52.9%患有高血压。不到一半的患者在基线时有记录的血脂情况。22例患者（9.5%）在开始ADT后有记录的心脏事件。
在这个来自中东的患者队列中，我们发现三分之一的人群在基线时已患有冠状动脉疾病，9.5%的患者在开始ADT时有记录的心脏事件。我们的研究突出了这一高危前列腺癌患者群体在心血管风险评估方面的差距，以及心血管合并症的高患病率。在开始ADT治疗之前，需要风险和资源分层算法以实现最佳的心血管健康。还需要肿瘤学家、泌尿科医生和心脏病专家之间提高认识、加强协作和建立转诊机制，以提供最佳护理。
