Cardiovascular Risk Triage Schema for Patients With Prostate Cancer Treated With Hormone Therapy
Avirup Guha, Ana Barac, Michael James Ryan, Randala Hamdan, Geeta Devgan, Catherine H. Marshall, Silke Gillessen, Stacy Loeb, Rana R. McKay, Emmanuel S. Antonarakis, Zachary Klaassen, Meenakshi Davuluri, Alan H. Bryce, Yun Rose Li, Nader El-Chaar, Stephanie Braun, Maha Hussain, Pedro Barata, Martin W. Schoen, Cora N. Sternberg, Tamara Jamaspishvili, Samuel L. Washington, Neal D. Shore, David Morris, Jack R. Andrews, Irbaz Bin Riaz, Daniel George, Soumyajit Roy, Gina B. Carithers, Phillip Koo, Neeraj Agarwal, Andrew W. HahnImportance
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.