title: Androgen deprivation and radiotherapy in patients with prostate cancer and cardiovascular risk factors: clinical controversies.
abstract: BACKGROUND
  Recent reports of an association between androgen deprivation treatment (ADT) and increased risk of cardiovascular (CV) events have generated debate on the use of ADT in patients with prostate cancer (PCa) and CV comorbidities. This study aims to describe the recommendations of radiation oncologists in the most controversial aspects of treating such patients.
  
  
  METHODS
  The project involved 61 oncologists and comprised 4 phases: (1) selection of the most controversial aspects in the administration of ADT in patients with a history of CV disease and PCa, (2) selection of the most relevant published evidence, (3) preparation of case reports, (4) critical reading and discussion. Therapeutic procedures were classified as "highly recommendable", "recommendable in some cases", or "not recommendable/not applicable". For each item assessed, the mode of the scores given, and the percentage of experts who selected each score were calculated.
  
  
  RESULTS
  The panel recommended that patients with high/very high-risk PCa and a history of CV disease should receive gonadotropin-releasing hormone agonists (GnRHa). ADT with GnRHa for 24-36 months + radiotherapy (RT) was also considered highly recommendable. In intermediate-risk PCa and a history of CV, ADT with GnRHa for 6-8 months + RT, and not administering ADT were considered highly recommendable.
  
  
  CONCLUSIONS
  Studies are necessary to investigate the impact of ADT on CV mortality in patients who benefit most from adjuvant ADT in terms of survival. In the meantime, the experts believe that clinical evidence on the proven therapeutic benefits of ADT should override concerns about potential cardiac toxicity.
authors.affiliation: Servicio de Oncología Radioterápica, Instituto de Investigación Sanitaria IIS-IP, Hospital Universitario de la Princesa, Diego de León 62, 28006, Madrid, Spain, almudena.zapatero@salud.madrid.org.
authors.forename: A
authors.initials: A
authors.lastname: Zapatero
authors.forename: C
authors.initials: C
authors.lastname: González San Segundo
authors.forename: A
authors.initials: A
authors.lastname: Boladeras
authors.forename: A
authors.initials: A
authors.lastname: Gómez Caamaño
authors.forename: J
authors.initials: J
authors.lastname: López Torrecilla
authors.forename: X
authors.initials: X
authors.lastname: Maldonado
mesh_terms: D000726:Androgen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D003131:Combined Modality Therapy; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D012307:Risk Factors
chemical_list: D000726:Androgen Antagonists; D007987:Gonadotropin-Releasing Hormone