Dr Sivatharshini Ramalingam
GP with a special interest in Cardio-Oncology
Dr Alex Lyon
Clinical Lead for Cardio-Oncology Service, Royal Brompton Hospital
Cardio-oncology specialists emphasise the effectiveness of prostate cancer treatments but underline the importance of monitoring the cardiovascular health of patients before, during and after their therapy.
Prostate cancer can be challenging for men to cope with, but treatment can also impact heart health. An important new subspecialty, cardio-oncology, is offering support to patients alongside cancer care. Specialists also point to the development of prostate treatments that have less impact on heart health, while still effectively targeting the cancer.
Care offered by cardio-oncology
Consultant cardiologist Dr Alexander Lyon, clinical lead of cardio-oncology services at the Royal Brompton Hospital (RBH) in London, explains that cardio-oncology focuses on the cardiovascular health in cancer patients throughout their care, particularly where a treatment may have introduced a cardiac issue.
With prostate cancer predominately affecting older men, Dr Lyon warns that patients may already have heart disease or cardiovascular risk factors — such as diabetes, high blood pressure or being overweight — when they arrive at their GP surgery with symptoms such as difficulty with urinary flow or erectile dysfunction.
“They are treated with prostate cancer drugs, but many of these drugs proven for prostate cancer can cause heart problems by aggravating the risk factors (mentioned above),” says Dr Lyon, who also chairs the European Society of Cardiology council in cardio-oncology.
Prostate cancer treatments
Prostate cancer treatment falls into the categories of surgery; radiotherapy; hormonal therapy and chemotherapy at advanced stages.
While oncologists have long been aware that targeting testosterone improves survival in prostate cancer patients, it is the hormone therapy that causes the heart issues, he says.
“Regular hormone treatments to reduce testosterone levels can raise cholesterol, introduce new diabetes, cause men to put on abdominal fat and lose muscle strength and bulk,” he says. These, he warns, can fuel development of the coronary disease that can lead to heart attacks or stroke.
PSA blood testing
Dr Sivatharshini Ramalingam, GP partner at Oxted Health Centre and a GP with a special interest in cardio-oncology, explains that every man over 50 in the UK is entitled to a PSA blood test for prostate cancer, though there is no national screening programme.
Those with a family history of prostate cancer; have a close relative who has had breast or ovarian cancer because of inherited genes; and older men should be tested.
Dr Ramalingam, who also works in the cardio-oncology department at RBH, says Black, African, and Caribbean men have a higher incidence of prostate cancer and should get a test.
Every man over 50 in the UK is entitled to a PSA blood test for prostate cancer, though there is no national screening programme.Dr Sivatharshini Ramalingam
Diagnostic process for prostate cancer
Dr Ramalingam acknowledges that men can feel embarrassed in raising their symptoms but suggests contacting their surgery via online GP access portals to request a PSA test.
“That opens the dialogue, and they can then ask a whole range of healthcare professionals from pharmacists to urgent care practitioners about a PSA test and will then be signposted to the appropriate person,” says Dr Ramalingam, who is also GP lead with the British Cardio-Oncology Society.
Patients with a positive PSA are fast-tracked for further investigation which will lead to an MRI scan to more accurately predict which patients need a biopsy. If cardiac issues are found, high-risk patients should be referred to a cardio-oncologist with treatment and prevention strategies available.
Treating the cancer while maintaining heart health
Specialists are now providing prostate cancer patients with closer cardiac assessment and monitoring (tailored to age, fitness and lifestyle), depending on whether they are low, medium or high-risk according to the 2022 ESC Cardio-Oncology Guidelines.
However, Dr Lyon stresses: “Cardio-oncology is about ensuring that cancer patients have their best cancer treatment safely, and a key component is patient education and awareness that they need to take an active role in helping improve their cardiovascular health.”