PDF(Pubmed)
Abstract：
Treatment intensification with androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPi) have led to improved survival in advanced prostate cancer. However, ADT is linked to significant cardiovascular toxicity, and ARPi also negatively impacts cardiovascular health. Together with a higher prevalence of baseline cardiovascular risk factors reported among prostate cancer survivors at diagnosis, there is a pressing need to prioritise and optimise cardiovascular health in this population. Firstly, While no dedicated cardiovascular toxicity risk calculators are available, other tools such as SCORE2 can be used for baseline cardiovascular risk assessment. Next, selected patients on combination therapy may benefit from de-escalation of ADT to minimise its toxicities while maintaining cancer control. These patients can be characterised by an exceptional PSA response to hormonal treatment, favourable disease characteristics and competing comorbidities that warrant a less aggressive treatment regime. In addition, emerging molecular and genomic biomarkers hold the potential to identify patients who are suited for a de-escalated treatment approach either with ADT or with ARPi. One such biomarker is AR-V7 splice variant that predicts resistance to ARPi. Lastly, optimization of modifiable cardiovascular risk factors for patients through a coherent framework (ABCDE) and exercise therapy is equally important. This article aims to comprehensively review the cardiovascular impact of hormonal manipulation in metastatic hormone-sensitive prostate cancer, propose overarching strategies to mitigate cardiovascular toxicity associated with hormonal treatment, and, most importantly, raise awareness about the detrimental cardiovascular effects inherent in our current management strategies involving hormonal agents.
摘要：
雄激素剥夺疗法（ADT）和雄激素受体途径抑制剂（ARPi）的强化治疗可改善晚期前列腺癌的生存率。然而,ADT与显著的心血管毒性有关,ARPi也对心血管健康产生负面影响。再加上在诊断时前列腺癌幸存者中报告的基线心血管危险因素的患病率较高，迫切需要在这一人群中优先考虑和优化心血管健康。首先,虽然没有专用的心血管毒性风险计算器可用，SCORE2等其他工具可用于基线心血管风险评估.接下来,接受联合治疗的选定患者可能受益于ADT的降级,从而在维持癌症控制的同时将其毒性降至最低.这些患者的特点是对激素治疗有特殊的PSA反应，有利的疾病特征和相互竞争的合并症，需要不太积极的治疗方案。此外,新兴的分子和基因组生物标志物具有鉴别适合ADT或ARPi降级治疗方法的患者的潜力.一种这样的生物标志物是预测对ARPi的抗性的AR-V7剪接变体。最后,通过连贯框架(ABCDE)和运动疗法优化患者可改变的心血管危险因素同样重要.本文旨在全面回顾激素治疗对转移性激素敏感型前列腺癌的心血管影响。提出总体策略，以减轻与激素治疗相关的心血管毒性，and,最重要的是,提高对我们当前涉及激素药物的管理策略固有的有害心血管影响的认识。
