JCO oncology practice · 2026
Cardiovascular Risk Triage Schema for Patients With Prostate Cancer Treated With Hormone Therapy.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Guha Avirup, Barac Ana, Ryan Michael James, Hamdan Randala, Devgan Geeta, Marshall Catherine H, Gillessen Silke, Loeb Stacy, McKay Rana R, Antonarakis Emmanuel S, Klaassen Zachary, Davuluri Meenakshi, Bryce Alan H, Li Yun Rose, El-Chaar Nader, Braun Stephanie, Hussain Maha, Barata Pedro, Schoen Martin W, Sternberg Cora N, Jamaspishvili Tamara, Washington Samuel L, Shore Neal D, Morris David, Andrews Jack R, Riaz Irbaz Bin, George Daniel, Roy Soumyajit, Carithers Gina B, Koo Phillip, Agarwal Neeraj, Hahn Andrew W
Аннотация
IMPORTANCE: Cardiovascular disease (CVD) is a leading noncancer cause of death among patients with prostate cancer (PC). Population-based risk calculators do not account for treatment-related effects of androgen-deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPis), and they have not been validated across PC treatment states.
OBSERVATIONS: This Prostate Cancer Foundation-sponsored clinician-industry consensus and narrative review proposes a pragmatic identification and triage schema for point-of-care use. The schema supports rapid risk capture, tier assignment, and referral or risk-factor optimization triggers; it does not provide cardiovascular therapeutic algorithms. We synthesize evidence on baseline cardiometabolic burden, ADT-associated adiposity and muscle-strength changes, plaque progression, ARPi-associated hypertension and cardiac events, suboptimal real-world risk-factor control, and social-needs barriers. Patients are classified as high risk when they have prior major cardiovascular events or established clinical atherosclerotic CVD; intermediate risk when they have no prior event but at least two uncontrolled or adverse risk factors; and low risk when neither criterion is met. We clarify cutpoints, the rationale for operational thresholding, essential versus optional intake elements, and capacity-sensitive referral pathways.
CONCLUSION AND RELEVANCE: The proposed three-tier schema should be viewed as a hypothesis-generating checklist for oncology, urology, radiation oncology, primary care, and cardiovascular teams. Prospective validation, workflow testing, calibration of referral thresholds, and inclusion of patient and clinic-staff stakeholders are required before broad implementation.
OBSERVATIONS: This Prostate Cancer Foundation-sponsored clinician-industry consensus and narrative review proposes a pragmatic identification and triage schema for point-of-care use. The schema supports rapid risk capture, tier assignment, and referral or risk-factor optimization triggers; it does not provide cardiovascular therapeutic algorithms. We synthesize evidence on baseline cardiometabolic burden, ADT-associated adiposity and muscle-strength changes, plaque progression, ARPi-associated hypertension and cardiac events, suboptimal real-world risk-factor control, and social-needs barriers. Patients are classified as high risk when they have prior major cardiovascular events or established clinical atherosclerotic CVD; intermediate risk when they have no prior event but at least two uncontrolled or adverse risk factors; and low risk when neither criterion is met. We clarify cutpoints, the rationale for operational thresholding, essential versus optional intake elements, and capacity-sensitive referral pathways.
CONCLUSION AND RELEVANCE: The proposed three-tier schema should be viewed as a hypothesis-generating checklist for oncology, urology, radiation oncology, primary care, and cardiovascular teams. Prospective validation, workflow testing, calibration of referral thresholds, and inclusion of patient and clinic-staff stakeholders are required before broad implementation.