Cardiovascular Risk and ADT Use in Prostate Cancer and Real-World Experience

In this episode, “Cardiovascular Risk and ADT Use in Prostate Cancer and Real-World Experience,” the panelists explore this question:

1. How does real-world evidence on cardiovascular outcomes with mono, doublet, and triplet therapy align with your clinical experience, and do they influence your treatment decisions?

Led by the moderator, the expert faculty examines emerging evidence on cardiovascular risk differences among androgen deprivation therapy (ADT) options, particularly gonadotropin-releasing hormone (GnRH) agonists vs antagonists. Faculty discuss data from the HERO and REVOLUTION trials, highlighting signals that oral GnRH antagonists such as relugolix may be associated with lower cardiovascular risk, including less progression of noncalcified coronary plaque. While acknowledging that much of the evidence remains hypothesis-generating, the panel emphasizes how these findings inform real-world treatment decisions, especially in patients with recent cardiovascular events. The discussion underscores the importance of integrating baseline and ongoing cardiovascular assessment into ADT selection while balancing biologic plausibility, clinical trial data, and payer constraints. Throughout the conversation, the experts offer a comprehensive reflection on the field and the factors that may shape clinicians' approach to care moving forward.

The next episode in this series, “Balancing Patient Preference and Access Challenges in Oral vs Injectable ADT in Prostate Cancer,” features the panelists discussing how patient-centered factors, such as autonomy, tolerability, frailty, and comfort with adherence, play a growing role in the choice between oral and injectable ADT. Improved coverage and cost protections have made oral ADT a more feasible and appealing option for many patients.