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Cardiovascular risks of androgen receptor targeted agents in prostate cancer: a systematic review and meta-analysis

Prostate Cancer and Prostatic Diseases (2024)Cite this article

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Abstract

Introduction

Androgen receptor targeted agents (ARTA) have increasingly been incorporated into treatment regimens for various stages of prostate cancer. Patients are living longer with prostate cancer, and thus have a higher cumulative exposure to the treatment and its accompanying side effects, especially those of cardiovascular disease. We aim to assess the differences in the incidence of cardiac-related adverse events after treatment of prostate cancer with ARTA versus placebo.

Methods

Three databases were thoroughly searched for relevant articles. The PICOS model was used to frame our clinical question, with which 2 independent authors went through several rounds of screening to select the final included studies. Meta-analysis was done using the Cochran-Mantel-Haenszel Method. Quality assessment was carried out with the Cochrane Risk of Bias tool RoB 2.

Results

The use of ARTA in prostate cancer increases the incidence of cardiac-related adverse events (RR: 1.56, 95% CI: 1.29–1.90, p < 0.00001), such as hypertension (RR: 1.69, 95% CI: 1.46–1.97, p < 0.00001), ischaemic heart disease (RR: 1.84, 95% CI: 1.36–2.50, p < 0.0001), and arrhythmia (RR: 1.38, 95% CI: 1.11–1.71, p = 0.004), although this did not manifest in an increased incidence of cardiac arrests/deaths (RR: 1.28, 95% CI: 0.87–1.88, p = 0.21).

Discussion

ARTA increases the risk of cardiac-related adverse events, hypertension, ischaemic heart disease and arrhythmia. Armed with this knowledge, we will be better poised to manage cardiac risks accordingly and involve a cardiologist as required when starting patients on ARTA.

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Fig. 1: PRISMA diagram.
Fig. 2: Quality assessment as per RoB 2.
Fig. 3: Forest plot of primary outcome.
Fig. 4: Forest plot of primary outcome.
Fig. 5: Forest plot of primary outcome.

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Data availability

Additional data is presented in the supplementary material. Further data is available on request.

Material availability

Additional data is presented in the supplementary material. Further data is available on request.

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Author information

Authors and Affiliations

  1. Department of Urology, National University Hospital, National University Health System, Singapore, Singapore

    Chloe Shu Hui Ong, Yu Xi Terence Law, Lin Kyaw, Qi Yang Lim, Ho Yee Tiong & Edmund Chiong

  2. Division of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore

    Tim Loke

  3. Raffles Urology Centre, Raffles Hospital, Singapore, Singapore

    Qing Hui Wu

  4. Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Edmund Chiong

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Contributions

CSHO conceived of and designed the meta-analysis, carried out data acquisition and analysis, and drafted and revised the manuscript. YXTL conceived of and designed the meta-analysis, carried out data acquisition and analysis, and drafted the manuscript. LK designed the meta-analysis, carried out data acquisition and analysis, and drafted the manuscript. QYL carried out data acquisition and analysis and drafted the manuscript. TL, QHW, HYT and EC participated in data analysis, revised the manuscript, and supervised the study. All authors read and approved the final manuscript and agree to be accountable for its publication.

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Correspondence to Chloe Shu Hui Ong.

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Ong, C.S.H., Law, Y.X.T., Kyaw, L. et al. Cardiovascular risks of androgen receptor targeted agents in prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis (2024). https://doi.org/10.1038/s41391-024-00792-5

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