Open Access

ARTICLE

Optimizing outcomes in men with prostate cancer: the cardiovascular event lowering (CaELo) pathways

E. David Crawford¹, David Albala², Marc B. Garnick³, Andrew W. Hahn⁴, Paul Maroni⁵, Rana R. McKay⁶, Martin Miner⁷, Peter Orio III⁸, Kshitij Pandit¹, Scott Sellinger⁹, Evan Y. Yu¹⁰, Robert H. Eckel¹¹

1 Department of Urology, University of California San Diego, La Jolla, California, USA
2 Department of Urology, Downstate Health Sciences Center, Brooklyn, New York, USA
3 Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
4 Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
5 Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
6 Department of Urology, Department of Medicine, University of California San Diego, La Jolla, California, USA
7 Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
8 Dana-Farber Brigham Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
9 Advanced Urology Institute, Tallahassee, Florida, USA
10 University of Washington, Fred Hutchinson Cancer Center, Seattle, Washington, USA
11 Division of Endocrinology, Metabolism, and Diabetes, Anschutz Medical Center, University of Colorado, Denver, Colorado, USA
Address correspondence to Dr. E. David Crawford, Dept. of Urology, University of California San Diego, Koman Family Outpatient Pavilion, La Jolla, CA 92037 USA

Canadian Journal of Urology 2024, 31(2), 11820-11825.

Abstract

Introduction: Risk of cardiovascular disease is higher among men with prostate cancer than men without, and prostate cancer treatments (especially those that are hormonally based) are associated with increased cardiovascular risk.
Materials and methods: An 11-member panel of urologic, medical, and radiation oncologists (along with a men’s health specialist and an endocrinologist/ preventive cardiologist) met to discuss current practices and challenges in the management of cardiovascular risk in prostate cancer patients who are taking androgen deprivation therapies (ADT) including LHRH analogues, alone and in combination with androgen-targeted therapies (ATTs).
Results: The panel developed an assessment algorithm to categorize patients by risk and deploy a risk adapted management strategy, in collaboration with other healthcare providers (the patient’s healthcare "village"), with the goal of preventing as well as reducing cardiovascular events. The panel also developed a patient questionnaire for cardiovascular risk as well as a checklist to ensure that all aspects of cardiovascular disease risk reduction are completed and monitored.
Conclusions: Prostate cancer patients receiving ADT with or without ATT need to be more zealously assessed for prevention and aggressively managed to reduce cardiovascular events. This can and should include participation from the entire multidisciplinary healthcare team.

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