Heart Failure Induced by Darolutamide in an Older Patient With M0 Castration-Resistant Prostate Cancer: A Case Report

Q4 Medicine

IJU Case Reports Pub Date : 2025-06-24 DOI:10.1002/iju5.70068

Yoshiyuki Miyaji, Shinjiro Shimizu, Michihiro Sato

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Abstract

Introduction

Androgen receptor signaling inhibitors (ARSIs) improve survival in prostate cancer; however, it may increase cardiovascular risks, especially in elderly patients with heart disease.

Case Presentation

A 94-year-old man with aortic valve stenosis, hypertension, and diabetes had a nodal metastatic progression of prostate cancer at 88 years of age, leading to the implementation of androgen deprivation therapy (ADT). After 5 years of therapy, prostate-specific antigen (PSA) re-elevated; however, ADT was maintained. At 94 years old, darolutamide was started due to worsening of urinary symptoms. Although these symptoms improved, the patient developed a heart failure with elevated B-type natriuretic peptide (BNP). Darolutamide was discontinued, leading to reduced BNP levels but increased PSA levels. A reduced dose (300 mg/day) resulted in stable PSA levels without BNP elevation.

Conclusion

Careful cardiovascular monitoring is crucial when ARSIs are used in older patients with heart disease. Dose adjustments may help balance oncological benefits and cardiac safety.

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Darolutamide致老年M0去势抵抗性前列腺癌心衰1例

雄激素受体信号抑制剂（ARSIs）可提高前列腺癌患者的生存率；然而，它可能会增加心血管疾病的风险，尤其是老年心脏病患者。一例94岁男性主动脉瓣狭窄、高血压和糖尿病患者在88岁时出现前列腺癌淋巴结转移进展，导致实施雄激素剥夺治疗（ADT）。治疗5年后，前列腺特异性抗原（PSA）再次升高；然而，ADT维持。94岁时，由于泌尿系统症状恶化，开始使用达鲁他胺。虽然这些症状有所改善，但患者发生心力衰竭，并伴有b型利钠肽（BNP）升高。停用达罗卢胺，导致BNP水平降低，但PSA水平升高。减少剂量（300mg /天）导致PSA水平稳定，没有BNP升高。结论老年心脏病患者应用arsi时，严密的心血管监测至关重要。剂量调整可能有助于平衡肿瘤益处和心脏安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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