To provide practical, evidence-based, and India-specific clinical guidance for managing cardiovascular risks in prostate cancer patients receiving androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPIs).
Approach:
Expert Panel Formation: The Prostate Cancer Cardiovascular (PCCV) Risk Expert Panel, consisting of urologists, oncologists, and cardio-oncologists from India, developed recommendations using a modified Delphi methodology.
Evidence Review: The panel reviewed evidence on the cardiovascular effects of ADT and ARPIs and contextualized it for Indian clinical practice.
Consensus Definition: Consensus was defined as ≥75% agreement among panelists.
Key Findings:
Comprehensive baseline lifestyle and cardiometabolic assessment is recommended.
Simplified cardiovascular risk checklists and baseline ECG and metabolic profiling should be utilized.
Patients should be stratified into low, intermediate, or high cardiovascular risk categories.
GnRH antagonists are preferred for high-risk patients, with referrals to cardiologists for intermediate or high-risk patients.
Ongoing cardiometabolic monitoring and lifestyle interventions are essential.
Interpretation:
The expert consensus emphasizes the need for proactive cardiovascular risk assessment and coordinated multidisciplinary management in prostate cancer patients, particularly in the context of increasing use of ADT and ARPIs.
Limitations:
The evidence base for recommendations is primarily derived from retrospective analyses and meta-analyses.
Prospective randomized trials are limited, underpowered, or prematurely terminated.
Conclusion:
Proactive cardiovascular risk assessment and individualized treatment selection are essential for improving long-term outcomes and quality of life for prostate cancer patients in India.
