After radiotherapy and bicalutamide for 4 plus 3 Gleason score 7, PSA has increased from a low of 2 to 6 in two years.
Now having bicalutamide 50mg plus arbiterone and hormone injections of either LHRH agonists or GmRH antagonists,
Have heart failure controlled by medication, just wondering if anyone has advice on blood tests and naything else pre empt any deterioration in heart due to testoserone suppression ?
I'd suggest talking about your concerns with your MO.
I wrote something about that topic. I am not a doctor. Formatting doesn't come through.
Essential Tests to Monitor Heart Failure Risk During Hormone Therapy
For patients on ADT (e.g., darolutamide, Lupron, orchiectomy) prioritize these tests to detect early cardiac dysfunction:
1. Blood Biomarkers
Test Purpose Frequency Target/Notes
BNP/NT-proBNP Detects cardiac strain/heart failure. Elevated levels = ↑HF risk. Every 3–6 months BNP <100 pg/mL; NT-proBNP <300 pg/mL
Troponin I: Assesses myocardial injury (e.g., ischemia, inflammation). Annually or if HF symptoms Normal high sensitivity troponin I <20 ng/L (high sensitivity tronopin T < 14 ng/L) (standard testing tronopin I <40 ng/L)
CBC (Hb, Hct, WBC) Monitors anemia (↓Hb/Hct) and inflammation (↑WBC). Every 3 months Hb >12 g/dL; WBC 4–10 ×10³/µL
Basic Metabolic Panel Tracks kidney function (creatinine, BUN) and electrolytes (K⁺, Na⁺). Every 3 months Creatinine <1.2 mg/dL; K⁺ 3.5–5.0 mM
Lipid Profile ADT ↑LDL/triglycerides. Monitor CVD risk. Annually LDL 40 mg/dL
hs-CRP Systemic inflammation marker linked to HF progression. Annually <2.0 mg/L (low risk)
Thyroid Panel Hypothyroidism exacerbates HF; common in ADT patients. Annually TSH 0.5–4.5 mIU/L
2. Cardiac Imaging
Test Purpose Frequency Notes
Echocardiogram Measures LVEF (heart function). LVEF <50% = systolic dysfunction. Annually Baseline + repeat if HF symptoms
ECG Detects arrhythmias, ischemia, or LV hypertrophy. Perform every 6 months if on QTc-prolonging drugs (e.g., darolutamide).
Otherwise, annually.
Especially if palpitations/chest pain
3. Special Considerations for Hormone Therapy
• ADT (e.g., darolutamide, Xtandi):
• ↑HF risk via LVEF decline (13.8% incidence in ADT patients vs. 6.1% non-ADT).
• Monitor BNP + echocardiogram closely if baseline LVEF <65% (high-risk cutoff).
• ADT increases insulin resistance. Monitor HbA1c annually (goal <7%) to detect diabetes early.
4. Actionable Thresholds
• Blood Pressure: Target <130/80 mmHg
• Statins: Consider initiating if LDL >100 mg/dL
• BNP >100 pg/mL or NT-proBNP >300 pg/mL: Refer to cardiology for HF workup.
• LVEF decline ≥10%: Consider pausing ADT and initiating HF medications (e.g., beta-blockers, ACE inhibitors).
• Hb <12 g/dL: Evaluate for anemia (common in ADT) and supplement iron/B12 if deficient.
5. Key Takeaways
• BNP + echocardiogram are the most critical tests for early HF detection.
• ADT patients require closer monitoring due to higher HF risk (13.8% vs. 6.1% in non-ADT).
• Discuss these tests and other appropriate ones with your MO and/or PCP.
Many thanks - much appreciated ! This is just what I was looking for.
You're welcome! Good luck.
Go to the head of the class...
Good Luck, Good Health and Good Humor.
j-o-h-n
Flashback to school days. Whenever the teacher would call me to the head of the class, bad stuff. Suspension or at least a trip to the Principal.
Great info on the blood tests. I've had two heart attacks, one stent and quad bypass surgery and am on Orgovyx, Zytiga and Prednisone. And nobody has mentioned having half of the tests done that you listed. I did have a question on the Troponin test, which one are you talking about? There are two different tests for Troponin, type T and type I. They are similar, but not the same and the results you are looking for would depend on which one you're testing. I've got a follow-up appointment with my heart doctor next month and I'm going show him the tests that you recommended and get his opinion...
Thanks. Let me know what he says.
Orgovyx has some CVD risk and AA, while a good drug, adds to it. In my case it was significant - HR went as high as 200+/120 and a visit to the cardiologist got me on BP meds.
Type I might be preferred. Both are good indicators but I is more common.
Thank you.
I edited my statement: "Troponin I: Assesses myocardial injury (e.g., ischemia, inflammation). Annually or if HF symptoms Normal troponin I <20 ng/L (tronopin T < 14 ng/L)"
And that is high-sensitivity tronopin I. The standard test isn't as good for cardiac risk monitoring, and normal is <40 ng/L.
Thanks for the quick reply. Right now, in addition to my ADT meds, I'm also on 100mg Metoprolol Tart, 50mg Losartan, 40 mg Atorvastatin, 5mg daily Tadalafil, twice daily Flomax, 7.5mg weekly Mounjaro, daily baby aspirin,150mg Wellbutrin XL and a daily dose of Metamucil to help clear thing out for the daily radiation treatments. I'm thinking about opening up my own drug store with all of the pills I'm taking...🤣🤣🤣
Similar story here. In addition to a BP med, a statin, a baby aspirin and Wellbutrin, I take half a dozen more. Love to reduce them but they all "seem" necessary to keep me going.
Have you ever tried a cyclical diet? Seven weeks ago I weighed 252. Today 221.
Zytiga can increase BP and also mess with electrolytes. Watch your potassium in your CMP testing. Supplementation is sometimes needed. Your doctor would know what might be best. In my case my sodium went down and I had to supplement with salt tablets.
Luckily, I've actually lost weight since I started on all of these drugs last year. Most of my bloodwork comes back within range with the exception of my A1c and fasting glucose which is slowly creeping up. Four months of ADT has knocked my PSA from 41 last Nov to .3 last week. But I had no idea how much losing your T would affect me. Mild hot flashes, complete loss of libido, forget having sex...the boys went out on strike two months ago and Taylor Swift could walk by me completely naked and I'd have no interest whatsoever. Definitely a weird feeling from what life was like before. I think it should be a job requirement that every Urologist, Oncologist and Rad Oncologist has to go on ADT treatment for at least a year before they are allowed to prescribe these life altering drugs. They might be a little more empathetic about what we are going thru...🤔🤔🤔
Lol! I think if Swift walked by I'd stand at attention...
Agreed. Before they prescribe it, try it. It's fun! Trust me!
Jubal Early (Firefly) felt the same thing.
And at the very minimum, talk to men before giving them this stuff. I had to learn on my own.
Look into tE2. Low dose. Might help the hot flashes.
Okay...times up, return to the back of the class.....
Good Luck, Good Health and Good Humor.
j-o-h-n
Thanks. I always loved the back of the class. Finally, my comfort zone!
I have to monitor my heart disease, which I believe is similar to heart failure. If you consume a heart-healthy diet, that also helps to control your pc, in general. By keeping saturated fats and sodium down, you help your heart as well as your pc. As for monitoring, watch your cholesterol serum level. Also watch sodium level and monitor blood pressure. Try to keep your weight down and also stay away from smoking and alcohol.
Thanks - much appreciated
Before I went on Abiraterone I was given an onco cardiologist consultation: ECG echo etc. Due to poor lifestyle choices of my close family I was deemed high risk and had a Heart CT angiogram. During this time I came across this very good book.
"Heart: an owner's guide" by Paddy Barret an Irish cardiologist. Published in 2024 so quite recent.
goodreads.com/book/show/199...
Very useful - many thanks - doesn’t seem to be many resources re cardio oncology about - and there are very few cardio oncologists too. You would think bearing in mind most men will be over 60 when they get diagnosed with PC that there is a large chance they would have developed cardiovascular problems and cardio oncology would have developed more as a science because of that ! I’ve also found the works of the late Dr Stephen Sinatra very good re complementary medicine - all of them are on Amazon.
Petabyte - forgot to ask ! If you don’t mind me asking what was your cardio oncologists view of Arbiterone re heart failure ? I’m due to see one next week and can compare notes…
Docetaxal prior to Hormone Therapy
Blood tests to monitor while on ADT..etc
Advice on Supplements needed
anyone takes relugolix and bitalucamide together ?
Testosterone level too high
