This issue is devoted to cardiovascular risk in prostate cancer patients. It turns out that the relationship is complex. Men with cardiovascular disease have a higher incidence of prostate cancer. This may, in part, be due to an impact of elevated cholesterol on prostate cancer progression. However, other factors may also be involved. For example, obesity is associated with an increased risk of cardiovascular disease and with progression of prostate cancer. Similarly, a diet rich in calories and meat is associated with an increase in insulin like growth factor 1 and this hormone has been liked to prostate cancer progression.
Removal of androgens, such as testosterone and dihydrotestosterone, plays a central role in the treatment of prostate cancer. In turn, low testosterone exacerbates insulin resistance, diabetes, visceral obesity and hypertension—known risk factors for cardiovascular disease.
In this issue, Dr. Pedro Barata from Tulane University gives us an overview of the issues at stake when we discuss prostate cancer and cardiovascular disease.
Dr. Michael Freeman from Cedars- Sinai discusses the evidence that cholesterol might drive progression in prostate cancer and the possibility that lowering cholesterol with statins might have a therapeutic impact. One of the more interesting observations he discusses is that certain gene expression patterns might lead to a increase or decrease in sensitivity to cholesterol levels.
Dr. Matthew Roe, a well-known cardiologist from Duke University’s Clinical Research Institute (DCRI), speaks about the PRONOUNCE clinical trial he’s running. PRONOUNCE compares the cardiovascular safety of Firmagon (degarelix) versus Lupron (leuprolide) in men with advanced prostate cancer. Dr. Darryl Leong from Canada’s McMaster University talks about his RADICAL-PC clinical trial, which evaluates the effectiveness of modifying cardiovascular and lifestyle risk factors in men who’ve just been diagnosed with prostate cancer.
Finally, Dr. Christina M. Dieli-Conwright talks about her clinical trial evaluating a 16-week program of cardiovascular and strength exercises in men with prostate cancer.
Charles E Myers, MD