FOIU 2018: Is there a "Cardio-friendly" ADT?

Tel-Aviv, Israel ( Bertrand Tombal, MD discussed whether there is a cardio-friendly androgen deprivation therapy (ADT). GnRH agonists are known to be associated with short-term increased risk of cardiovascular disease (CVD), especially in men with the pre-existing disease. Additionally, all men undergo metabolic changes with time. There has been published data showing a lower risk for degarelix when compared to agonists for CVD in patients with a CVD history (4.5% vs. 9.4%). 1

Tombal moved on and stated that we as physicians can have a significant effect on the metabolic status of the patient. In a study randomizing patients receiving radiotherapy for PC to either usual care, aerobic exercise program or resistance exercise program, the metabolic status and quality of life were assessed.2 The median adherence to the prescribed exercise protocol was 85%. Both resistance and aerobic exercise mitigated. Resistance training and aerobic exercise improved quality of life, aerobic fitness, upper and lower body strength, and triglycerides while preventing an increase in body fat.

Another study presented demonstrated that an exercise program, low glycemic index diet, and metformin is given to patients with PC receiving ADT has a significant effect in reducing systolic blood pressure, body fat, and abdominal waist circumference (Figure 1). 3

Figure 1: The effect of an exercise program, low glycemic index diet, and metformin in prostate cancer patients receiving ADT compared to standard of care:
UroToday FOIU2018 The effect of an exercise program on ADT
Unfortunately, antiandrogens cause cardiovascular toxicity. There is a known association between ADT and diabetes, coronary artery disease, myocardial infarction, sudden death, and stroke. (Figure 2). 4

Figure 2 – Association of hormonal therapy to diabetes and coronary heart disease:
UroToday FOIU2018 Association of hormonal therapy to diabetes and coronary heart disease

Tombal concluded his talk by mentioning 2 of his published studies, where enzalutamide was given as monotherapy in hormone naïve PC patients, demonstrating an overall beneficial effect, 5,6 demonstrating that other drugs might have a more favorable outcome, in regards to CVD.

1. Albertson PC et al. Eur Urol 2014
2. Segal RJ et al. J Clin Oncol 2009
3. Nobes JP. Et al. BJU Int. 2012
4. Keating N. et al. J Natl Cancer Inst 2010; 102: 39-46
5. Tombal B. et al. Lancet Oncol 2014
6. Tombal B. et al. Eur Urol 2015

Presented by: Bertrand Tombal, MD, Brussels, Belgium

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