Dr Sieber on the Importance of Evaluating Comorbidities in Prostate Cancer Prior to ADT

Paul Sieber, MD, medical director, Clinical Trials, Keystone Urology, discusses the importance of evaluating comorbidities in patients with prostate cancer, including assessing risk factors for cardiovascular events in those who are initiating androgen deprivation therapy (ADT).

At the 2023 AUA Annual Meeting, investigators presented data from a claims-based study with the goal of evaluating cardiovascular events in patients with prostate cancer who are being treated with ADT. Notably, investigators watched for patients who had 1 or more of these 3 common comorbidities: diabetes mellitus, hypertension, and hyperlipidemia. Furthermore, investigators included patients who had begun ADT a minimum of 12 months prior to study enrollment and continued ADT for at least 6 months after. It was found that 7.6% of patients with only hypertension experienced cardiovascular events following ADT; 7.3% of patients with only hyperlipidemia experienced cardiovascular events after ADT; and 9.9% of patients with both hypertension and hyperlipidemia had cardiovascular events following ADT. Furthermore, 14.4% of patients who experienced a cardiovascular event post-ADT initiation had only diabetes, and patients with all 3 of these comorbidities had a 16.1% risk of a cardiovascular event after starting ADT.

When urologists treat patients with prostate cancer, they should pay close attention to patient comorbidities, Sieber begins. Although oncologists are mindful of some comorbidities, such as old age, some do not recognize comorbidities as often as necessary, and should also pay closer attention to the projected lifespan of these patients, he explains. Because of these unmet needs, it is important to aim to better understand patient comorbidities when making treatment recommendations, Sieber says. This is an easy first step in recognizing this vital topic, Sieber emphasizes.

Although investigators have identified that patients with prostate cancer who receive ADT are at risk for cardiovascular events, the next steps for addressing this issue are unclear, Sieber notes. For instance, it is unknown whether a cardiac calcification score is enough to assess patient risk, or whether patients need a stress test, Sieber explains. Moving forward, it is important to establish a standard for assessing the risk for cardiovascular events in this population, he concludes.