A new study out of MD Anderson Cancer Center and University of Texas Medical Branch tells a cautionary tale: “men with prostate cancer are at risk for competing morbidity and mortality from age-related cardiometabolic diseases.”^[i] This sounds pretty scary. Why would having prostate cancer (PCa) be connected with higher risk of illness and death from heart disease, obesity, diabetes, etc.?

The answer lies in the natural process of aging, and the fact that the risk of of prostate cancer increases as men grow older. The Prostate Cancer Foundation breaks down the trend of prostate cancer incidence by age:

Although only about 1 in 456 men under age 50 will be diagnosed, the rate shoots up to 1 in 54 for ages 50 to 59, 1 in 19 for ages 60 to 69, and 1 in 11 for men 70 and older. Nearly 60% of all prostate cancers are diagnosed in men over the age of 65.

Aging also brings risks of other disease conditions. The World Health Organization points out that as people age they’re more likely to have overlapping problems. “Common conditions in older age include hearing loss, cataracts and refractive errors, back and neck pain and osteoarthritis, chronic obstructive pulmonary disease, diabetes, depression and dementia.” Furthermore, according to American Senior Communities, “Heart disease is the leading cause of death for adults over the age of 65. Conditions like high blood pressure and high cholesterol need to be managed properly and taking good care of your heart are vital to avoid developing heart disease in your later years.”

That’s exactly the point the MD Anderson team is trying to make. While it’s true that many men younger than 65 develop PCa (in 2019, 37% of prostate cancer cases were diagnosed among men aged 45 to 64 years^[ii]), if they’re leading healthy lifestyles they are unlikely to be obese, diabetic, and have cardiovascular problems at the time of PCa diagnosis.

Concurrently, there’s another alarming PCa trend. Since 2014, the rate of diagnosing PCa when it’s already at an advanced stage has risen by 5% each year. Some experts attribute this in part to the changing guidelines regarding PSA screening. In spite of the flaws of PSA screening, it has helped with early detection. Thus, if fewer men are being annually screened, many are missing that window. Men whose PCa is diagnosed when it has already begun to leave the gland are put on androgen deprivation therapy (ADT) to halt the growth and progression of their disease—but one side effect of such “chemical castration” to cut off testosterone fuel for the cancer cells is greater risk for heart problems. “Numerous studies have found increased incidence of myocardial infarction (MI), stroke, arrhythmia, hypertension, and sudden cardiac death (SCD) in men receiving ADT. Cardiovascular disease is already the second leading cause of death in men with prostate cancer,” write Fradin, et al. (2023).^[iii]

Assessing cardiometabolic risk in PCa patients

MD Anderson has a special division in their Cancer Center called the Healthy Heart Program. When PCa patients are referred into it for the purpose of assessing and lowering their cardiometabolic risks, they are seen by a heart specialist and an exercise physiologist. They are evaluated in multiple categories: blood pressure, cholesterol, blood glucose, tobacco use, and coronary artery disease.

The research team gathered the following data from 55 PCa patients who were referred into the Healthy Heart Program between Dec. 2018 – Oct. 2021. Out of those patients, 55 had advanced PCa (either rising PSA after treatment, proven locoregional recurrence, or distant metastasis). All had received at least one dose of ADT. The authors report that at the time of enrollment,

• 93% were overweight or obese
• 51% had intermediate or high risk of arterial/cardiovascular disease within 10 years
• 84% had an overlap of two or more cardiometabolic disease
• 25% had an overlap of at least 4 cardiometabolic disease
• 45% had high blood pressure which was not controlled by medication
• 26% had high cholesterol which was not controlled by medication

And yet, patient follow-up was poor. The authors theorize that perhaps they were receiving their cardio care elsewhere, with their own doctors—or not at all.

The importance of ascertaining the overall cardiometabolic wellness of PCa patients at the time of their cancer diagnosis cannot be overemphasized. The view of PCa treatment has gradually been shifting from an intensive immediate crisis to management of PCa as a chronic disease. Men are living longer with recurrent, advanced PCa using a treat-and-manage approach. However, as they are continuing to age, “cardiometabolic diseases are chronic, impacted by lifestyle, at risks for subsequent major adverse cardiovascular events,” write the authors. “As clinical investigators and clinicians, we must shift the cognitive framework for prostate cancer in a subset of men to define prostate cancer as an age-related event that shares biology with other cardiometabolic diseases. Thus, caring for cardiometabolic health also becomes caring for the prostate cancer.”^[iv] In short, PCa may begin in the prostate gland, but the health of the whole person is ultimately what’s at stake.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Hahn AW, Thoman W, Koutroumpakis E, Abdulla A et al. Cardiometabolic healthcare for men with prostate cancer: an MD Anderson Cancer Center experience. Cardiooncology. 2023 Sep 13;9(1):33.
[ii] United States Cancer Statistics. “Prostate Cancer Incidence by Stage at Diagnosis, 2001-2019. https://www.cdc.gov/cancer/uscs/about/data-briefs/no34-prostate-cancer-incidence-2001-2019.htm
[iii] Fradin J, Kim FJ, Lu-Yao GL, Storozynsky E, Kelly WK. Review of Cardiovascular Risk of Androgen Deprivation Therapy and the Influence of Race in Men with Prostate Cancer. Cancers (Basel). 2023 Apr 15;15(8):2316.
[iv] Hahn et al. ibid.