A man diagnosed with prostate cancer is much more
likely to die of cardiac disease and not from prostate cancer, unless the diagnosis is made at a
very late stage. For that reason, a man's cardiac history, his cardiovascular risk factors,
and the choice of which drug to use for ADT, Hormone Therapy, are very critical issues. Androgen deprivation therapy, ADT, the mainstay
of treatment for years, is associated with a 10-20% increased risk of cardiac complications, such as a heart attack, stroke, or sudden death. If a man has already had two important
cardiac events before starting ADT, the risk of another cardiac event is greatly increased. Surprisingly these serious problems can occur within the first 6 – 12 months after starting treatment. Degarelix (Firmagon), the newer drug for ADT,
is less toxic to the heart than leuprolide, (Lupron), and, for many clinicians, is
becoming the preferred agent for hormone therapy. Every man before starting ADT needs a thorough evaluation for cardiac risk factors.
This exam should focus on past history of cardiovascular disease, hypertension, diabetes,
elevated cholesterol and triglycerides, and life-style factors such as diet and exercise. In some men this pre-ADT evaluation will lead to choosing Firmagon over Lupron, or receiving
the shortest period of hormone therapy as possible, or beginning a program for modification of
cardiac risk factors or possibly avoiding the use of these drugs entirely. Prostate Cancer Free Foundation
https:prostatecancerfree.org.
