Evaluating clinical tools to monitor cardiovascular (CV) risk in men with localized high-risk or locally advanced prostate cancer (LHRPC) treated with hormone therapy (HT).

Abstract

116 Background: Androgen deprivation therapy (ADT) and androgen receptor signaling inhibitors (ARSIs) indirectly increase CV risk. There are no risk estimation tools specific to men with prostate cancer undergoing HT. Current practice utilizes tools designed for the general population, such as the AHA/ACC ASCVD risk score. Herein, we investigate the applicability of such general population risk tools in men receiving pre-operative HT for LHRPC. Methods: We conducted a retrospective analysis of men with LHRPCa who received 6 months of pre-operative ADT + apalutamide +/- abiraterone on NCT. Cardiometabolic factors of interest were extracted from the electronic medical record, and ASCVD risk scores were calculated alongside metabolic syndrome (MetS) Z scores (calculated using ASCVD calculator https://tools.acc.org/ldl/ascvd_risk_estimator/#!/calulate/estimator/ and metabolic syndrome severity calculator https://metscalc.org/metscalc/ ). Results: Sixty-four patients had data available to calculate baseline and end-of-treatment (EOT) ASCVD risk and MetS Z scores. Prior to initiation of HT, 46.8% of patients were on antihypertensive treatment, 11.3% had diabetes mellitus, and 45.2% were on lipid-lowering therapy. After 6 months of ADT + ARSI, the median change in ASCVD risk score was 0.95, and 21% of patients exhibited a clinically significant increase in ASCVD risk score of ≥ 2.5%. The median change in the metabolic syndrome Z score was -0.36, indicating a decrease in metabolic syndrome risk. 28% of all patients demonstrated an increase in metabolic syndrome risk after 6 months of HT. Conclusions: Despite the known association between HT and increased CV risk, most patients in this study did not experience a clinically meaningful increase in either ASCVD risk or MetS Z score. These findings suggest that general population risk estimation tools may not reflect temporal evolution of CV risk in patients undergoing HT. This study also highlights an unmet need for novel risk assessment tools specifically tailored to identify at-risk men among those treated with HT.