The Prostate Cancer Foundation (PCF) today announced the publication of a new consensus framework designed to help clinicians identify and manage cardiovascular risk in patients receiving hormone therapy. The framework, “Cardiovascular Risk Triage Schema for Patients With Prostate Cancer Treated With Hormone Therapy,” – developed through PCF’s Clinician-Industry Roundtable – was published in JCO Oncology Practice, an American Society of Clinical Oncology journal.

Cardiovascular disease is the leading cause of death in patients with prostate cancer. Androgen-deprivation therapy (ADT), a commonly used hormone treatment for prostate cancer, can contribute to cardiovascular risk; and androgen receptor pathway inhibitors (ARPIs), which are often used alongside ADT in advanced prostate cancer care, can increase the risk of hypertension and cardiovascular events. Yet, commonly used cardiovascular risk calculators do not account for the treatment-related effects of ADT and ARPIs and have not been validated across prostate cancer treatment states.

The new framework proposes a simple three-tier approach to help oncology, urology, radiation oncology, primary care and cardiovascular teams identify patients who may benefit from cardiovascular risk-factor management or referral. The triage schema is intended for point-of-care use with patients who are starting, receiving or escalating hormone therapy and is designed to complement existing cardiovascular risk assessment rather than replace it.

“Patients with prostate cancer face substantial and often underrecognized cardiovascular risk, particularly when ADT is initiated or treatment is intensified,” said Avirup Guha, MBBS, MPH, of Georgia Cancer Center, Medical College of Georgia at Augusta University, and lead author of the cardiovascular risk triage schema. “Our goal was to give healthcare providers a practical way to recognize risk early and coordinate prevention without delaying cancer treatment.”

“Cardiovascular disease is the leading cause of death for men with prostate cancer, yet the tools clinicians rely on weren’t built for patients on hormone therapy,” said Gina Carithers, President and CEO of the Prostate Cancer Foundation. “This framework is a practical first step, and we encourage care teams to put it into practice and help us measure its impact. Treating the cancer and protecting the heart must go hand in hand.”

Practical Three-Tier Approach to Cardiovascular Risk

To develop the framework, the roundtable collaborators conducted a narrative review of published research, clinical trial registries, major society guidance and pivotal clinical trials, and used a consensus process to develop a three-tier approach for cardiovascular disease risk identification.

Participants in the development of the framework included specialists in cardio-oncology, cardiology, genitourinary medical oncology, urology and radiation oncology, as well as academic investigators and PCF representatives. The authors recommended that the framework be piloted and evaluated prospectively, including its effect on cardiovascular outcomes, delivery of cancer therapy, clinical workflow, and referral practices.

  • High risk: Focused on patients with a prior major cardiovascular event or established clinical atherosclerotic cardiovascular disease. The consensus recommends concurrent cardiology or cardio-oncology referral while oncology care proceeds, except when a red-flag cardiovascular presentation requires stabilization.

  • Intermediate risk: Aimed at patients without a prior cardiovascular event who have at least two uncontrolled or adverse risk factors. Recommendations include risk-factor management with closer monitoring and consideration of cardiology or cardio-oncology involvement when patients are starting or escalating ADT or an ARPI.

  • Low risk: Directed at patients without a prior cardiovascular event and with fewer than two uncontrolled cardiovascular risk factors. For this group, the framework suggests routine annual reassessment and reevaluation if therapy changes or new risk factors emerge.

About the Prostate Cancer Foundation

The Prostate Cancer Foundation® (PCF®) is the world’s leading philanthropic organization dedicated to funding life-saving prostate cancer research. Founded in 1993 by Mike Milken, PCF has raised more than $1 billion to fund cutting-edge research through more than 2,615 research projects at 312 leading cancer centers, with a global footprint spanning 29 countries. Since PCF’s inception, and through its efforts, patients around the world are living longer, suffering fewer complications, and enjoying better quality of life. PCF is committed to the mission of ending death and suffering from this disease. Learn more at www.pcf.org.

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