Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Increased Risk Following Oral Androgen Signaling Inhibitors in PCa Patients With Pre-existing CVDs

Key clinical point: Patients with pre-existing cardiovascular diseases (CVDs) experienced higher short-term mortality after abiraterone acetate or enzalutamide than those without.

Major finding: After treatment with abiraterone acetate or enzalutamide, elderly PCa patients with pre-existing CVDs experienced higher short-term mortality than otherwise similar patients without CVDs.

Study details: 2,845 with abiraterone acetate and 1,031 with enzalutamide, who had prostate cancer participated in a population-based retrospective study.


Lu-Yao G, et al. Eur Urol. 2019 Aug 2. doi: 10.1016/j.eururo.2019.07.031.


Cardiovascular diseases (CVD) are highly prevalent in the patient population at highest risk for prostate cancer. Abiraterone acetate and enzalutamide are ubiquitously used in metastatic disease, yet in the studies leading to widespread use of these agents, patients with significant CVD were often excluded. Due to limited options for patients with metastatic disease, patients with CVD are often treated with these agents out of necessity. The study by Lu-Yao supports the notion that patients with pre-existing CVD may have less benefit compared to patients included in the original studies and affirms increased attention should be directed toward CVD in these patients. —Mark A. Klein, MD