Dalia Kaakour, MD, on cardiometabolic risks with NHTs for prostate cancer

In the following video, Dalia Kaakour, MD, MPH, discusses key findings from a retrospective review of cardiovascular system toxicities in patients initiating novel hormonal therapies (NHTs) for advanced prostate cancer. These results were presented at the 2026 American Society of Clinical Oncology Genitourinary Cancers Symposium in San Francisco, California.¹

Kaakour is a hematology and oncology fellow at the University of California, Irvine.

For the study, the investigators examined men with advanced prostate cancer receiving a newly initiated NHT between 2022 and 2025. The analysis included patients treated with abiraterone acetate (Zytiga; 44.6%), darolutamide (Nubeqa; 41%), enzalutamide (Xtandi; 8.7%), and apalutamide (Erleada; 5.6%), although the primary comparison focused on abiraterone vs darolutamide due to larger sample sizes.

Baseline rates of hypertension (62.1% vs 57.5%), hyperlipidemia (49.4% vs 53.8%), and diabetes (25.3% vs 28.9%) were similar between patients receiving abiraterone vs darolutamide. However, patients initiating abiraterone were more likely to require new medications for hypertension (30% vs 16.3%) and hyperlipidemia (18.4% vs 10%) compared with those receiving darolutamide, while no difference was observed in the initiation of diabetes medications (21.8% vs 21.3%).

According to Kaakour, the absence of an observed difference in diabetes-related treatment may reflect gaps in monitoring rather than true equivalence in risk. Kaakour noted that hemoglobin A1c is not routinely assessed in oncology practice, and patients with advanced prostate cancer may rely primarily on their oncologist for care, with less consistent follow-up in primary care settings. As a result, cases of treatment-emergent diabetes may be underrecognized.

REFERENCE
1. Kaakour D, Ozaki A, Cho E, et al. Development of cardiovascular disease risk factors in patients with prostate cancer initiating novel hormonal therapies (NHTs): Real world evidence. Presented at: 2026 American Society of Clinical Oncology Genitourinary Cancers Symposium. February 26-28, 2026. San Francisco, California. Abstract 146. https://www.asco.org/abstracts-presentations/256617