Cardiovascular Risk Triage Schema for Patients With Prostate Cancer Treated With Hormone Therapy.

Abstract

Importance: Cardiovascular disease (CVD) is a leading noncancer cause of death among patients with prostate cancer (PC). Population-based risk calculators do not account for treatment-related effects of androgen-deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPis), and they have not been validated across PC treatment states.

Observations: This Prostate Cancer Foundation-sponsored clinician-industry consensus and narrative review proposes a pragmatic identification and triage schema for point-of-care use. The schema supports rapid risk capture, tier assignment, and referral or risk-factor optimization triggers; it does not provide cardiovascular therapeutic algorithms. We synthesize evidence on baseline cardiometabolic burden, ADT-associated adiposity and muscle-strength changes, plaque progression, ARPi-associated hypertension and cardiac events, suboptimal real-world risk-factor control, and social-needs barriers. Patients are classified as high risk when they have prior major cardiovascular events or established clinical atherosclerotic CVD; intermediate risk when they have no prior event but at least two uncontrolled or adverse risk factors; and low risk when neither criterion is met. We clarify cutpoints, the rationale for operational thresholding, essential versus optional intake elements, and capacity-sensitive referral pathways.

Conclusion and relevance: The proposed three-tier schema should be viewed as a hypothesis-generating checklist for oncology, urology, radiation oncology, primary care, and cardiovascular teams. Prospective validation, workflow testing, calibration of referral thresholds, and inclusion of patient and clinic-staff stakeholders are required before broad implementation.