FOIU 2018: Epidemiology: The RADICAL PC Trial

Tel-Aviv, Israel (UroToday.com) Jehonathan Pinthus, MD presented the RADICAL PC trial and elaborated on the correlation of prostate cancer (PC) to cardiovascular disease (CVD). It is known that PC patients are at risk for CVD.1 Patients are deemed to be high-risk if they have a global risk estimate for severe CVD events with a rate of more than 2% per year. This risk increases significantly if patients are treated with hormonal therapy (Table 1).1 In PC patients not treated with androgen deprivation therapy (ADT) the risk of myocardial infarction (MI), stroke, or cardiovascular death is more than 2% year. This risk increases to more than 4% per year when patients are treated with ADT.2

Table 1 – Incidence of cardiovascular disease per year in prostate cancer patients:
UroToday FOIU2018 Incidence of cardiovascular disease per year in prostate cancer patients
Pinthus then discussed the RADICAL PC1 trial (The role of androgen deprivation therapy in cardiovascular disease – a longitudinal prostate cancer study), which has accrued 1790 patients to date in 15 Canadian sites. There is another study, that sprung from the RADICAL PC1 study, which is the RADICAL PC2 trial (A randomized intervention for cardiovascular and lifestyle risk factors in prostate cancer patients). 

The hypothesis of this trial is that ADT is the ‘straw that breaks the camel’s back’, adding significantly to the variety of comorbidities that accompany PC patients, increasing their CVD risk (Figure 1). The objective of RADICAL PC2 is to determine whether systematic CV and lifestyle risk factor modification strategy reduce the risk of CVD in men with a new PC diagnosis who are commencing ADT. There are several risk reductions strategies for CVD (Table 2). Study outcomes will be CV death, MI, stroke, heart failure, arterial revascularization. According to the study protocol, patients will be contacted by telephone at 3, 6 ,12, 18, 24, and 36 months to assess clinical outcomes. The results of this trial are eagerly awaited.

Figure 1 – The role of androgen deprivation therapy in the risk of cardiovascular disease in prostate cancer patients:
UroToday FOIU2018 The role of androgen deprivation therapy in the risk of cardiovascular disease in prostate cancer patients

Table 2- Risk reduction in the general population for cardiovascular disease:
UroToday FOIU2018 Risk reduction in the general population for cardiovascular disease

References:
1. Keating et al. JNCI 2010; 102:39
2. O’farrell, et al. JCO 2015; 102:39

Presented by: Jehonathan Pinthus, MD, Mcmaster University, Canada

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan  at the 2018 FOIU 4th Friends of Israel Urological Symposium, July 3-5. 2018, Tel-Aviv, Israel
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