Cardiovascular complications of antineoplastic treatment in prostate cancer patients and compensatory strategies for clinical management.

Abstract

Prostate cancer (PCa) is one of the most common malignancies among men worldwide. Advances in systemic therapies, including androgen deprivation therapy (ADT), androgen receptor-targeted agents, chemotherapy, poly(ADP-ribose) polymerase (PARP) inhibitors, and immunotherapy, have substantially improved survival outcomes. However, these therapeutic advances have also led to increased recognition of treatment-related cardiovascular toxicity. Cardiovascular disease is highly prevalent among patients with prostate cancer and remains a major cause of morbidity and mortality, underscoring the importance of integrating cardiovascular care into oncologic management. This review summarizes the principal cardiovascular complications associated with contemporary prostate cancer therapies and discusses current strategies for their prevention and management. ADT has been associated with metabolic dysfunction, hypertension, arrhythmias, and increased cardiovascular risk. Androgen receptor-targeted agents and androgen biosynthesis inhibitors may further contribute to hypertension, fluid retention, ischemic heart disease, and cardiac rhythm disturbances. Additional therapies, including taxane-based chemotherapy, PARP inhibitors, and immune checkpoint inhibitors, have also been linked to myocardial dysfunction, hypertension, QT prolongation, and immune-mediated myocarditis, although the incidence and severity vary across therapeutic classes. Given the increasing complexity of prostate cancer treatment, early cardiovascular risk stratification and close monitoring during therapy are essential. Baseline cardiovascular evaluation, regular assessment of blood pressure and metabolic parameters, electrocardiographic surveillance, multimodality cardiovascular imaging, and appropriate management of pre-existing cardiovascular disease are critical components of patient care. A multidisciplinary cardio-oncology approach is essential to minimize cardiovascular toxicity while preserving the therapeutic benefits of modern prostate cancer treatment.