Why Testosterone Blocking Can Put Stress on the Heart in the Treatment of Prostate Cancer
Prostate cancer treatment frequently involves balancing the risk of severe side effects with the goal of controlling the malignancy. Turning off testosterone, the hormone that drives aggressive prostate cancers, is one of the best ways to slow them down. However, recent studies support what many physicians have long suspected: that approach can be costly when it comes to heart health.
Combining testosterone-blocking medications dramatically raises the risk of cardiovascular problems, according to an increasing amount of research. This should serve as a stark reminder to men who have prostate cancer, whether it is advanced or not: sometimes, what helps the cancer can also hurt the heart.
What are testosterone-blocking drugs?
Prostate cancer cells thrive on testosterone. To deprive them, doctors utilize androgen deprivation therapy (ADT), which essentially turns off the body’s testosterone manufacturing. Androgen receptor signaling inhibitors (ARSIs), a more recent class of drugs, prevent testosterone from binding to receptors that permit cancer cells to absorb it, but they do not prevent testosterone production.
When combined, ARSIs and ADT provide a potent one-two punch against prostate cancer. This pairing, known as intensified ADT, is often reserved for advanced cases but is now being explored for men in earlier stages of the disease.
The problem is that this combination does not appeal to your heart.
A comprehensive assessment of 24 clinical trials with approximately 22,000 males aged 63–77 was released in June 2024 by British researchers. From early yet aggressive tumors to advanced cases when ADT alone was no longer helpful, these individuals had prostate cancer at a range of stages.
What happens to the heart when ARSIs are added to regular ADT was the sole subject of the study.
The results were depressing.
The risk of cardiovascular events, such as high blood pressure, abnormal heart rhythms, blood clots, heart attacks, and strokes, was almost quadrupled when ARSIs were added. The risk varied from 7.8% to 15.6% for severe incidents (graded as Grade 3, necessitating hospitalization).
Using two ARSIs together (abiraterone acetate and enzalutamide) seemed to triple the probability of a cardiac event in the most concerning situations. Even worse, there is no evidence that this combination of drugs improves survival rates, and international expert panels are increasingly recommending against using it.
Who is most in danger?
It should come as no surprise that men with pre-existing heart issues were most affected by enhanced therapy. However, males who did not have a heart condition were not exempt. Heart disease is the second most common cause of mortality for males with prostate cancer, according to Dr. Katelyn Atkins, a radiation oncologist at Cedars-Sinai. It is frequently overlooked until it is too late, particularly in elderly individuals.
Before recommending severe testosterone suppression, she advises physicians to examine for atherosclerosis, a silent accumulation of plaque in the coronary arteries. Early detection of latent heart problems may help avoid issues later on.
What can men do, then?
Heart risks can be changed; they are not a life sentence. The good news is that.
Experts say that males can significantly lessen adverse effects by adopting easy, preventative measures:
Reduce your blood pressure.
Eat a diet high in fiber, healthy fats, and whole foods to protect your heart.
Get frequent exercise, even if it is just walking.
If your doctor prescribes statins or other cholesterol-lowering drugs, take them into consideration.
The University of Colorado's Dr. David Crawford, a urologic oncologist, stressed that controlling side effects does not entail reducing cancer therapy. Instead, it entails treating prostate cancer holistically, protecting your entire body rather than just the tumor.
"It is not only about adding additional drugs in cancer care," he stated, "but about mixing them correctly and maintaining the patient's entire health."
The bottom line
Combining testosterone-blocking medications can save lives. They do carry some risk, though. These new findings are a wake-up call for men who have been diagnosed with prostate cancer: safeguard your heart in addition to treating the cancer.
Make sure to ask your oncologist the following questions:
How likely am I to get heart disease while undergoing treatment?
Can we check for undiagnosed cardiac conditions?
What lifestyle adjustments can I make right now to stay safe?Stacking the deck in your advantage on both fronts is the goal.
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