Cardiovascular Risk Triage Schema for Patients With Prostate Cancer Treated With Hormone Therapy

Importance Cardiovascular disease (CVD) is a leading noncancer cause of death among patients with prostate cancer (PC). Population-based risk calculators do not account for treatment-related effects of androgen-deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPis), and they have not been validated across PC treatment states. Observations This Prostate Cancer Foundation–sponsored clinician-industry consensus and narrative review proposes a pragmatic identification and triage schema for point-of-care use. The schema supports rapid risk capture, tier assignment, and referral or risk-factor optimization triggers; it does not provide cardiovascular therapeutic algorithms. We synthesize evidence on baseline cardiometabolic burden, ADT-associated adiposity and muscle-strength changes, plaque progression, ARPi-associated hypertension and cardiac events, suboptimal real-world risk-factor control, and social-needs barriers. Patients are classified as high risk when they have prior major cardiovascular events or established clinical atherosclerotic CVD; intermediate risk when they have no prior event but at least two uncontrolled or adverse risk factors; and low risk when neither criterion is met. We clarify cutpoints, the rationale for operational thresholding, essential versus optional intake elements, and capacity-sensitive referral pathways. Conclusion and Relevance The proposed three-tier schema should be viewed as a hypothesis-generating checklist for oncology, urology, radiation oncology, primary care, and cardiovascular teams. Prospective validation, workflow testing, calibration of referral thresholds, and inclusion of patient and clinic-staff stakeholders are required before broad implementation.

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Publication Details

Journal
JCO Oncology Practice
Published
2026-09-28
DOI
https://doi.org/10.1200/op-26-00312
Primary Topic
Chemotherapy-induced cardiotoxicity and mitigation
Type
article
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article

Cardiovascular Risk Triage Schema for Patients With Prostate Cancer Treated With Hormone Therapy

Jack R. Andrews, Cora Nanette Sternberg, Silke Gillessen, Irbaz Bin Riaz et al.
JCO Oncology Practice
Chemotherapy-induced cardiotoxicity and mitigation
article

Cardiovascular Risk Triage Schema for Patients With Prostate Cancer Treated With Hormone Therapy

Jack R. Andrews, Cora Nanette Sternberg, Silke Gillessen, Irbaz Bin Riaz, Geeta Devgan, Emmanuel S. Antonarakis, Daniel J. George, Andrew Warren Hahn, Alan Haruo Bryce, Ana Barac, Stacy Loeb, Randala Hamdan, Maha Hussain, Avirup Guha, Pedro Coelho Barata, Catherine Handy Marshall, Martin William Schoen, Michael J. Ryan, Rana R. McKay, Samuel L. Washington, Soumyajit Roy, Zachary William Abraham Klaassen, Neal D. Shore, David S. Morris, Neeraj Agarwal, Leslie A. Lange, Tamara Jamaspishvili, Stephanie Braun, Phillip Koo, Meenakshi Davuluri, Gina B. Carithers, Nader El-Chaar
article en

Abstract

Importance Cardiovascular disease (CVD) is a leading noncancer cause of death among patients with prostate cancer (PC). Population-based risk calculators do not account for treatment-related effects of androgen-deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPis), and they have not been validated across PC treatment states. Observations This Prostate Cancer Foundation–sponsored clinician-industry consensus and narrative review proposes a pragmatic identification and triage schema for point-of-care use. The schema supports rapid risk capture, tier assignment, and referral or risk-factor optimization triggers; it does not provide cardiovascular therapeutic algorithms. We synthesize evidence on baseline cardiometabolic burden, ADT-associated adiposity and muscle-strength changes, plaque progression, ARPi-associated hypertension and cardiac events, suboptimal real-world risk-factor control, and social-needs barriers. Patients are classified as high risk when they have prior major cardiovascular events or established clinical atherosclerotic CVD; intermediate risk when they have no prior event but at least two uncontrolled or adverse risk factors; and low risk when neither criterion is met. We clarify cutpoints, the rationale for operational thresholding, essential versus optional intake elements, and capacity-sensitive referral pathways. Conclusion and Relevance The proposed three-tier schema should be viewed as a hypothesis-generating checklist for oncology, urology, radiation oncology, primary care, and cardiovascular teams. Prospective validation, workflow testing, calibration of referral thresholds, and inclusion of patient and clinic-staff stakeholders are required before broad implementation.

JCO Oncology Practice
Northwestern University (US), Inova Health System (US), City Of Hope National Medical Center (US), The University of Texas MD Anderson Cancer Center (US), Johns Hopkins University (US), Bayer (United States) (US), Duke University (US), University of California, San Francisco (US), Pfizer (United States) (US), Queen's University (CA), Cornell University (US), University of Utah (US), Augusta University (US), Prostate Cancer Foundation (US), University of California San Diego (US), NYU Langone Health (US), Augusta University Health (US), Presbyterian Hospital (US), Urology Associates (US), St. Louis VA Medical Center (US), City of Hope (US), University Hospitals Seidman Cancer Center (US), Mayo Clinic in Arizona (US), Mayo Clinic Hospital (US), VA St. Louis Health Care System (US), Carolina Urologic Research Center (US), Astellas Pharma (United States) (US), UCSF Helen Diller Family Comprehensive Cancer Center (US), Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Moores Cancer Center, Duke Cancer Institute, Masonic Cancer Center, Università della Svizzera italiana (CH), New York University (US), Case Western Reserve University (US)
Reduced inequalities
Openalex Percentile: Top 11%
Chemotherapy-induced cardiotoxicity and mitigation
DOISourceOpenAlex
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