Top Line: Even among men with prostate cancer, cardiovascular disease–not cancer–remains the leading cause of death.
The Study: This should remain front of mind when prescribing any form of androgen deprivation therapy (ADT). The pragmatic international RADICAL PC2 trial randomized 2,487 patients with prostate cancer to usual care versus routine referral to an internist or cardiologist for systematic cardiovascular risk reduction. Nearly half received ADT and more than a quarter prostate radiation. The intervention included diet and exercise counseling, smoking cessation, antihypertensive medication for systolic BP >130, and, finally–now here is where they lost us–statin therapy irrespective of cholesterol level. After a median follow-up approaching 6 years, the intervention arm achieved, as you’ll be shocked to hear, a significantly lower mean total cholesterol (-12 mg/dL). There was no difference in the more clinically meaningful time to cardiovascular event (i.e., cardiovascular death, myocardial, stroke, and heart failure) as the trial was not powered to demonstrate differences here given anticipated low event rate over a short follow-up period. Here is a perhaps more helpful prespecified subgroup analysis suggesting the intervention was most beneficial in men with modifiable cardiovascular risk at baseline (read: total cholesterol >155 mg/dL or BP ≥130/80). Who would have thought.
TBL: Similar to ensuring standard up-to-date colonoscopy screening prior to initiating prostate radiation, it is best practice to ensure standard cardiac risk factor screening prior to initiating ADT in order to optimize concurrent–again, standard–lipid and blood pressure management. | Leong, JAMA Intern Med 2026 & Cano Garcia, JACC 2026
The Study: This should remain front of mind when prescribing any form of androgen deprivation therapy (ADT). The pragmatic international RADICAL PC2 trial randomized 2,487 patients with prostate cancer to usual care versus routine referral to an internist or cardiologist for systematic cardiovascular risk reduction. Nearly half received ADT and more than a quarter prostate radiation. The intervention included diet and exercise counseling, smoking cessation, antihypertensive medication for systolic BP >130, and, finally–now here is where they lost us–statin therapy irrespective of cholesterol level. After a median follow-up approaching 6 years, the intervention arm achieved, as you’ll be shocked to hear, a significantly lower mean total cholesterol (-12 mg/dL). There was no difference in the more clinically meaningful time to cardiovascular event (i.e., cardiovascular death, myocardial, stroke, and heart failure) as the trial was not powered to demonstrate differences here given anticipated low event rate over a short follow-up period. Here is a perhaps more helpful prespecified subgroup analysis suggesting the intervention was most beneficial in men with modifiable cardiovascular risk at baseline (read: total cholesterol >155 mg/dL or BP ≥130/80). Who would have thought.
TBL: Similar to ensuring standard up-to-date colonoscopy screening prior to initiating prostate radiation, it is best practice to ensure standard cardiac risk factor screening prior to initiating ADT in order to optimize concurrent–again, standard–lipid and blood pressure management. | Leong, JAMA Intern Med 2026 & Cano Garcia, JACC 2026