Impact of androgen deprivation therapy and androgen receptor pathway inhibitors on cardiac structure and function evaluated by echocardiography in males with prostate cancer: a systematic review and meta-analysis.

PURPOSE: Androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPIs) are cornerstones in the treatment of prostate cancer (PC), but are associated with adverse cardiovascular effects. The objective of this work was to systematically review and analyse cardiac structure and function in PC patients undergoing therapy with ADT or ARPIs as assessed with echocardiography.

METHODS

The work was pre-registered with Prospero (CRD42024539717). We searched PubMed/Medline, Ovid/Embase, Cochrane Library, and Google Scholar on January 7th, 2025. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 were followed. Studies with PC patients treated with ADT or ARPI, compared to baseline, and assessed with echocardiography were included. Quality was assessed using the Newcastle-Ottawa Scale and Risk of Bias 2. Mean differences in echocardiographic measurements during treatment compared to baseline were assessed in meta-analyses.

RESULTS

Six studies (three prospective cohort studies, one retrospective cohort study, and two randomised trials) with 560 patients all examining the influence of ADT on echocardiographic parameters were included in the meta-analysis, which showed a reduction in left ventricular (LV) ejection fraction (- 2.32%, 95% CI [- 3.82, - 0.82], p = 0.0025, I2 = 73.5%), changes in LV mass index (- 7.95 g/m2 (95%CI: - 12.16, - 3.74), I2 = 0%, p = 0.00), LV end-systolic volume, (+ 3.62 mL (95%CI: 1.98, 5.26) I2 = 0%, p =  < 0.0001), LV end-systolic volume index (+ 1.82 mL/m2 (95%CI: - 12.16, - 3.74), I2 = 11,6%, p = 0.003), and aortic root diameter (+ 0.40 mm, (95%CI: 0.00, 0.80), I2 = 0%, p = 0.0480) after ADT therapy. The included studies exhibited heterogeneity in study populations and follow-up time. Limited evidence was found on ARPIs, as only one study with limited data was found.

CONCLUSIONS

PC patients undergoing ADT may experience reduced LV systolic function compared to baseline, indicative of cardiomechanical deterioration due to ADT. Important limitations include possible publication bias and heterogeneity in included studies, which highlight the need for larger studies.