Androgen deprivation therapy and cardiological risks in patients with prostate cancer. Are all drugs the same?

Prostate cancer (PCa) is the most common oncological disease in men in Russia. For a long time, long-term androgen deprivation therapy (ADT) decreasing native testosterone level has been the basis of PCa drug therapy. At the time of PCa diagnosis, 2/3 of men have various risk factors for cardiovascular diseases (CVDs) or established CVDs (one fourth of the patients have CVDs associated with atherosclerosis; 45 % have a diagnosis of arterial hypertension). ADT is associated with increased risk of CVD and cardiovascular complications (CVC) development. Patients with PCa die of 2 main causes: directly due to cancer or due to CVD. Previously, luteinizing hormone-releasing hormone (LHRH) antagonists were considered to have a better safety profile compared to LHRH agonists. Comparison of all LHRH agonists (leuprorelin, triptorelin, goserelin, buserelin) with LHRH antagonists in meta-analyses showed that the risk of serious CVCs during LHRH antagonist therapy was 43 % lower than during agonist therapy. However, comparison of leuprorelin with antagonists did not show a significant difference in CVC rate. Leuprorelin is a drug with the most favorable profile of cardiological safety among the ADT drugs and the most frequently used LHRH agonist in the world. Considering high risk of CVDs and CVCs in patients with PCa, along with treatment of the main disease, careful control and reduction of risks of CVD development from the moment of PCa diagnosis should be implemented, the patients must be informed on the necessity of healthy lifestyle, established CVDs should be treated with rational regimens of antihypertensive, hypolipidemic, and hypoglycemic drugs. Risk control and reduction, as well as CVD treatment, should be performed for the whole duration of ADT. The article proposes an algorithm of cardiometabolic risk stratification prior to ADT initiation and during ADT.