Moryousef Joseph, Duivenvoorden Wilhelmina, Leong Darryl, Pinthus Jehonathan H
Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada.
The Research Institute of St. Joe's Hamilton, Hamilton, ON, Canada.
Prostate Cancer Prostatic Dis. 2024 Nov 6. doi: 10.1038/s41391-024-00897-x.
The prevalence of cardiovascular risk factors and disease is high in patients with newly diagnosed prostate cancer (PC). Survivorship of PC patients is often determined by cardiovascular disease (CVD). Our review synthesizes the most recent literature exploring the dynamics between PC and CVD across the disease trajectory and treatments. We review key ongoing clinical trials in the field and highlight avenues for future study.
We conducted a comprehensive narrative review of the literature using various search strategies in three databases (PubMed, Web of Science, ClinicalTrials.gov), focusing on literature published between 2000 and 2024.
We discuss the significance of CVD-related mortality in PC, review the risk factors, and highlight potential mechanisms for accelerated CVD in the androgen-deprivation setting. Furthermore, we summarize key literature of CVD and cardiotoxicity for various therapeutic approaches in PC, including orchiectomy, taxane-based chemotherapy, GnRH-axis targets, and next-generation hormonal agents and PARP inhibitors. Lastly, we discuss prevention strategies and the importance of multi-disciplinary care in this setting.
CVD is a major cause of death in men with PC. Various novel therapeutic approaches have been pivotal in improving oncologic outcomes, but emerging data demonstrate a complex interplay between the androgen axis and CVD that is likely affected by modern treatment strategies. Given the prolonged PC survivorship, unraveling non-oncologic related causes of death and investigating prevention strategies are imperative (Fig. 1). Fig. 1 LANDSCAPE OF PROSTATE CANCER.: Spectrum of prostate cancer disease states (red) and interventions (yellow) with the potential role for optimization (green) to improve cardiovascular outcomes in the future (blue).
新诊断前列腺癌（PC）患者中，心血管危险因素和疾病的患病率很高。PC患者的生存情况通常由心血管疾病（CVD）决定。我们的综述综合了最新文献，探讨了PC与CVD在疾病发展轨迹和治疗过程中的动态关系。我们回顾了该领域正在进行的关键临床试验，并强调了未来的研究方向。
我们使用多种检索策略在三个数据库（PubMed、科学网、临床试验.gov）中对文献进行了全面的叙述性综述，重点关注2000年至2024年发表的文献。
我们讨论了PC中与CVD相关的死亡率的重要性，回顾了危险因素，并强调了雄激素剥夺情况下CVD加速的潜在机制。此外，我们总结了PC中各种治疗方法（包括睾丸切除术、紫杉烷类化疗、GnRH轴靶点、新一代激素药物和PARP抑制剂）的CVD和心脏毒性的关键文献。最后，我们讨论了预防策略以及在这种情况下多学科护理的重要性。
CVD是PC男性患者的主要死亡原因。各种新型治疗方法在改善肿瘤学结局方面发挥了关键作用，但新出现的数据表明雄激素轴与CVD之间存在复杂的相互作用，这可能受到现代治疗策略的影响。鉴于PC患者的生存期延长，阐明非肿瘤相关的死亡原因并研究预防策略势在必行（图1）。图1前列腺癌概况：前列腺癌疾病状态（红色）和干预措施（黄色）的范围，以及未来优化（绿色）以改善心血管结局的潜在作用（蓝色）。
