Prostate cancer, even in its advanced forms, is much more treatable today than it was in the past. Androgen deprivation therapy (ADT), in which medications are used to limit the body’s production of testosterone, has proven to be one of the most effective treatments available as it often halts the progress of the cancer or can even cause it to shrink — but it is not without its risks.

Increased cardiovascular risk

Among prostate cancer patients with pre-existing heart disease or heart disease risk factors, some ADT medications may substantially increase their risk of heart attacks or other cardiovascular events. When treating cancer, it’s important to remember that other health outcomes matter too. “There are other factors beyond cancer that affect your survival,” says Dr. Ilias Cagiannos, Urologic Oncologist and Associate Professor of Surgery at the University of Ottawa. “Cardiovascular events remain a significant cause of death even in cancer patients. The most important thing at the end of the day is the overall survival rate, not just the cancer-specific survival rate.”

A perfect demographic storm

Both prostate cancer and cardiovascular disease are found more commonly with increasing age. These conditions may therefore be simultaneously present in the same individual. In fact, approximately one-third of patients with metastatic prostate cancer treated with ADT also have pre-existing cardiovascular disease. The good news is that there are a range of different ADT medications, and studies have shown that some have far fewer cardiovascular effects than others. For those at risk, this can be one important factor in choosing which medication to use. “From a cancer treatment point of view, the drugs available are fairly equivalent,” explains Dr. Cagiannos. “But in someone with pre-existing cardiovascular disease the difference in risk can be significant.”

It’s critical that all prostate cancer patients for whom ADT is an option be screened for cardiovascular disease and risk factors. It’s a simple screening that can save lives. “When I’m initiating ADT, I tell all my patients that there may be an association between these drugs and cardiovascular health,” Dr. Cagiannos notes. “I advise all patients to follow up with their family doctor and get a general assessment of cardiac risk factors done.” This assessment can help your doctor pick the ADT best suited for you.