Prostate Cancer Study Finds No Added Heart Risk from ADT With Radiation in Veterans
A large Veterans Affairs cohort study published in Cardiooncology brings timely nuance to a long-running concern in prostate cancer care: whether adding androgen deprivation therapy (ADT) to radiation therapy (RT) heightens the risk of major adverse cardiovascular events (MACE). Drawing on records from men treated within the US Department of Veterans Affairs between 2000 and 2015 and followed through March 26, 2021, investigators assembled a retrospective cohort of 39,580 patients and applied rigorous 1:1 propensity score matching to create two balanced analytic samples—17 352 men matched on treatment (ADT + RT versus RT alone) and 12 544 matched on race (Black versus White). MACE was defined as a composite of cardiovascular death, myocardial infarction, or ischemic stroke.
The headline finding will reassure many clinicians. Among men without pre-existing cardiometabolic disease (CMD), those receiving ADT + RT were less likely to experience MACE than peers treated with RT alone. In stratified analyses of the matched cohort, ADT + RT was associated with a lower MACE rate in men free of CMD at baseline (hazard ratio 0.46; 95% CI 0.27–0.78), suggesting that in carefully selected patients, intensifying oncologic therapy need not exact a cardiovascular penalty. Conversely—and critically for day-to-day practice—pre-existing CMD powerfully dominated risk regardless of cancer treatment choice. In both unmatched and matched models, men with CMD had markedly higher hazards of MACE whether they received RT alone or ADT + RT, underscoring the primacy of metabolic and cardiovascular health in shaping outcomes after prostate cancer therapy.
The study also interrogated racial disparities within an equal-access system. After propensity matching on key clinical and sociodemographic factors, Black and White Veterans experienced similar time to MACE, and the interaction between race and treatment type was not significant. Race-stratified models did reveal some differences in how traditional risk features tracked with events—for example, White men with intermediate or unknown National Comprehensive Cancer Network (NCCN) risk appeared more MACE-prone than White men with low risk—but the overarching message was parity in MACE incidence by race when access and baseline characteristics were balanced.
Several contextual signals merit attention. Overall MACE incidence in this VA population was low at 0.6%, lower than rates reported in some non-Veteran cohorts, a difference that may reflect coordinated care and improved contemporary risk management. Diagnosis in more recent years correlated with fewer events in both Black and White Veterans, hinting at progress in cardiometabolic surveillance and treatment. Rural residence was not associated with MACE after adjustment.
As with all retrospective analyses, caution is warranted. Events treated outside the VA may be undercaptured, and treatment pathways that diverge from guidelines could confound associations. Even so, the scale, careful matching, and harmonized access environment strengthen the takeaway. For Veterans with high-risk prostate cancer—especially those without existing cardiometabolic disease—ADT combined with RT does not inherently raise cardiovascular event risk. The dominant modifiable lever is pretreatment optimization of CMD and multimorbidity, making proactive cardiovascular screening and management an essential companion to evidence-based prostate cancer care.
Reference
Lucas AR, Bastiach D, Dahman B, et al. Major adverse cardiovascular events among black and white veterans receiving androgen deprivation therapy for prostate cancer: a retrospective cohort study. Cardiooncology. 2025;11(1):12. Published 2025 Feb 6. doi:10.1186/s40959-025-00312-x
