Sanoj Punnen, MD, on balancing ADT efficacy with cardiovascular safety

In an interview at the 2026 American Urological Association (AUA) Annual Meeting in Washington DC, Sanoj Punnen, MD, discussed the growing emphasis on balancing the oncologic benefits of androgen deprivation therapy (ADT) with its potential cardiovascular risks in patients with prostate cancer. Punnen is a professor of urologic oncology and associate professor and vice chair of research at the University of Miami Desai Sethi Urology Institute in Florida.

Punnen explained that the session was developed in response to feedback from AUA members identifying cardiovascular safety as an area requiring greater education. Although ADT remains a cornerstone of treatment for many patients with advanced prostate cancer, he noted that growing evidence has highlighted the impact of testosterone suppression on metabolic health and cardiovascular risk. In addition to well-recognized effects on bone health and muscle strength, ADT has been associated with changes in lipid and metabolic profiles, and emerging data suggest that some therapies may contribute to increased coronary plaque burden after relatively short treatment durations.

When selecting an ADT strategy, Punnen said treatment duration and cardiovascular risk should both be considered. He noted that gonadotropin-releasing hormone antagonists appear to be associated with a lower risk of plaque buildup and major adverse cardiovascular events than agonists, making them an attractive option when clinically appropriate. However, he emphasized that urologists have not traditionally been trained to assess cardiovascular risk and may need greater familiarity with factors such as prior myocardial infarction or stroke, statin use, and hypertension control before initiating therapy.

To address these challenges, Punnen advocated for a multidisciplinary approach to patient care. He emphasized the importance of involving primary care physicians, cardiologists, medical oncologists, and urologists in shared decision-making to better identify and mitigate cardiovascular risk throughout ADT treatment.