How to cite: Crawford ED; Scarpato, K. Cardiovascular Risk During Systemic Therapy for Prostate Cancer. Grand Rounds in Urology. October 2026. Accessed Oct 2026. https://grandroundsinurology.com/cardiovascular-risk-during-systemic-therapy-for-prostate-cancer/
Summary
In this UroDummies discussion, E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, speaks with Kristen Scarpato, MD, MPH, Associate Professor of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, about cardiovascular risk associated with androgen deprivation therapy (ADT) and other systemic therapies used in prostate cancer.
Dr. Scarpato emphasizes that urologists prescribing ADT, androgen receptor pathway inhibitors, or poly(ADP-ribose) polymerase inhibitors should consider the patient’s broader medical history rather than focusing exclusively on prostate cancer. She recognizes hormone deprivation as contributing to cardiovascular risk through metabolic changes and notes that risk can increase with longer treatment duration and combinations of therapies. Patients with existing cardiovascular risk factors may require additional monitoring and coordination with cardiology, cardio-oncology, or other members of the healthcare team.
Dr. Crawford highlights previous major adverse cardiovascular events, hypertension, and diabetes as examples of factors that warrant attention. They discuss practical challenges in obtaining cardiology consultations and the potential role of primary care clinicians in coordinated management.
Before systemic therapy begins, Dr. Scarpato recommends establishing a broader baseline assessment. In addition to prostate-specific antigen and testosterone, she discusses checking hemoglobin A1C and lipid levels and obtaining a baseline electrocardiogram. These evaluations may identify patients who require further consultation before therapy begins. Throughout the conversation, Dr. Scarpato emphasizes treating and monitoring the whole patient when systemic prostate cancer therapy is prescribed.
ABOUT THE AUTHOR
Researcher-physician E. David Crawford, MD, Jack A. Vickers Director of Prostate Research and Professor of Urology at the University of California, San Diego, San Diego, California, has devoted his career in medicine to educating the public about men's health issues and finding effective techniques and procedures to address prostate cancer, the most common malignancy affecting men in the United States.
Kristen Scarpato, MD, MPH, is Associate Professor of Urology at Vanderbilt University Medical Center (VUMC) in Nashville, Tennessee. She holds the William L. Bray Endowed Chair of Urology and serves as Vice Chair of Education and Residency Program Director.
