The project I presented on yesterday was on the topic of cardio-oncology in prostate cancer. We know that patients with non-metastatic prostate cancer are actually at a higher risk of morbidity from cardiovascular comorbidities, cardiometabolic syndrome, and deaths related to that, for example MI, stroke, etc. Patients with metastatic prostate cancer, although there’s a higher chance of death related to the prostate cancer than cardiovascular disease, the incidence of cardiovascular disease and comorbidities is actually still higher in that population. I think it’s overall an understudied topic as far as which novel hormonal therapies give higher risk compared to each other. Even if you go a little more granular, we can look at hypertension, hyperlipidemia, diabetes, which drugs are causing more risk, and then even the timeline of when those risks develop - are there more shorter-term risks, long-term risks? That was kind of the background on where our questions stem from.
What we did is we conducted a retrospective chart review at our institution, UCI, from 2020 to 2025 where we looked at patients with advanced prostate cancer who were newly started on a novel hormonal therapy which included abiraterone, apalutamide, enzalutamide or darolutamide.
We had 87 patients newly started on abiraterone and 80 patients newly started on darolutamide. Apalutamide and enzalutamide each had 11 patients for each of their groups, so my analysis focused mostly on comparing the abiraterone group to the darolutamide group. Interestingly the baseline rates of diabetes, hypertension and hyperlipidemia were about the same. I used medication new-start as kind of a proxy for the development of a co-morbidity like hypertension, hyperlipidemia, or diabetes. So we looked at new start of medication for all three of those groups respectively. New starts of anti-hypertensives or medications for hyperlipidemia were quite a bit higher in the abiraterone group compared to the darolutamide group, however new start of medication for diabetes, which included any medication for diabetes, they were about comparable, about the same in both of those groups.
I was asking myself why that might be and I don’t necessarily think we can say that patients just aren’t developing a higher rate of diabetes or pre-diabetes even in one group compared to the other, but I think a lot of times in oncology we’re not regularly checking hemoglobin A1Cs or acting on mildly, or even maybe moderately, elevated glucose levels. Of course if a patient has very high glucose where if it’s more of an acute threat we would act on it, but I think probably we might be missing some development of pre-diabetes/diabetes in this population, so maybe that has to do with it.
It’s also possible that the hypertension is more easily detected, it’s being checked at every patient visit, so we’re acting on it more, maybe we’re more likely to check lipid levels or there’s a more short-term effect of the medications causing hyperlipidemia versus maybe the metabolic derangement to the glucose A1C is more longer term, it’s possible.
What is next for this study?
I think we need again more granular information on comparing the agents to see which agents have higher risk and of what risk factors. That way we can have better information for our patients and have, again, another layer of information on who we should prescribe what based on this part of it. Of course we have the side effect profile and other comorbidities we look at too that we have more information on, so I think that’s helpful.
Another thing I think is helpful moving forward is having better risk stratification so that we can have earlier cardio-oncology intervention and referral. Make it more mainstream in the prostate cancer world to do early referral to cardio-oncology just to optimise patients. Also because sometimes because our patients, when they have cancer, will be more focused on just their cancer rather than their cardiovascular health or general health, so I think integrating this would be a next step.
