Best ADT for CVD?: My husband is going... - Advanced Prostate...

Advanced Prostate Cancer

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Best ADT for CVD?

11 Replies

My husband is going to have ADT + Zytiga +radiation (prostate +lymph nodes pelvis + metastasis) in an aggressive approach to oligometastatic cancer (T3b, N1 M1, Gleason 9). He is fit but has atheroscleroses and will need stents.

Now for ADT I thought Degarelix would be the best choice regarding CVD.

They propose Zoladex + Casodex instead.

And adding Zytiga could be even more dangerous for CVD, so I am not sure we should begin with it, since he is getting "curative" radiation.

What are your thoughts or experiences?

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11 Replies
tango65 profile image
tango65

Abiraterone could be associated with negative cardiovascular events:

ascopost.com/News/59787

The testosterone suppression should probably be done with Firmagon instead of lupron or similar, to also suppress the FSH.

sciencedirect.com/science/a...

grandroundsinurology.com/th...

in reply to tango65

I agree, strange that my oncologist in a team with a cardiologist didn't come to this conclusion...

Tall_Allen profile image
Tall_Allen

I thought he was having Xofigo first, as in the Finnish study, no?

in reply to Tall_Allen

No, because he does not have a big burden, I don't know how they count, but should be 4 mets.

Tall_Allen profile image
Tall_Allen in reply to

Xofigo works better when the met burden is lower. Also, toxicity increases when met burden is higher.

academic.oup.com/jnci/advan...

onlinelibrary.wiley.com/doi...

nature.com/articles/s41391-...

jnm.snmjournals.org/content...

ncbi.nlm.nih.gov/pmc/articl...

in reply to Tall_Allen

Interesting. Is there any study comparing Xofigo to direct radiation to low burden metastasis?

Tall_Allen profile image
Tall_Allen in reply to

No - but there is no question that Xofigo is a better first step. There is actual data proving it works whereas met-directed therapy is anyone's guess.

Advo__cate profile image
Advo__cate

Did you see the links I posted in one of your other posts? The PRONOUNCE study is still in progress, I think?? we wish we had stayed with an antagonist that seems to carry less of a burden.

in reply to Advo__cate

Yes, I have seen, thank you! we would prefer degarelix!

Advo__cate profile image
Advo__cate in reply to

I think it should be the only ADT option for those with preexisting CVD. MO should go with your preference, without any hesitation.

Tall_Allen profile image
Tall_Allen

This Mendelian randomization study is the best evidence I've seen that excess testosterone is a cause of CVD. There's probably some optimum level.

bmj.com/content/364/bmj.l476

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