Which ADT Is Safer for the Heart for Prostate Cancer?

When it comes to treating prostate cancer androgen deprivation therapy (ADT) is one of the most common approaches. ADT works by lowering testosterone levels, which helps slow or stop the growth of prostate cancer cells. But while it can be effective against cancer, many patients and doctors are increasingly asking an important question: which type of ADT is safer for the heart?

Prostate cancer is one of the most frequently diagnosed cancers in men worldwide. According to the World Health Organization, it remains a major health concern, especially in older men. ADT has long been a standard treatment for advanced or high-risk prostate cancer, but growing evidence suggests that not all forms of ADT carry the same cardiovascular risks.

Understanding the Two Main Types of ADT

There are two primary categories of ADT medications: GnRH (gonadotropin-releasing hormone) agonists and GnRH antagonists.

GnRH Agonists such as leuprolide and goserelin initially cause a surge in testosterone before dramatically lowering levels. This temporary spike is sometimes referred to as a “testosterone flare.”

GnRH Antagonists, on the other hand, suppress testosterone more directly and quickly, without causing an initial surge.

While both approaches aim to achieve the same goal—reducing testosterone—their effects on the cardiovascular system may differ.
The Link Between ADT and Heart Health

Lowering testosterone affects more than just cancer cells. Testosterone plays a role in metabolism, muscle mass, fat distribution, and blood vessel function. ADT has been associated with increased risks of weight gain, insulin resistance, higher cholesterol levels, and inflammation. All of these factors can contribute to heart disease.

The American Heart Association has highlighted concerns that certain prostate cancer treatments may elevate cardiovascular risk, particularly in men who already have heart disease or risk factors like diabetes or high blood pressure.

Recent clinical studies suggest that GnRH antagonists may pose a lower risk of major cardiovascular events compared to GnRH agonists, especially in men with pre-existing heart conditions. Researchers believe that avoiding the initial testosterone surge and reducing inflammatory responses could be key factors.
Who Is Most at Risk?

Men with a history of heart attack, stroke, or heart failure appear to be at greater risk of cardiovascular complications during ADT. For these patients, choosing the type of hormone therapy carefully is critical. Cardiologists and oncologists are increasingly working together to tailor treatment plans based on individual heart health profiles.
Balancing Cancer Control and Cardiac Safety

It’s important to remember that ADT remains a life-saving therapy for many men. The goal is not to avoid treatment but to select the safest option possible. For patients with significant cardiovascular risk, GnRH antagonists may offer a safer alternative. However, treatment decisions must consider cancer stage, overall health, cost, availability, and patient preference.

Lifestyle changes also play a major role. Regular exercise, a heart-healthy diet, blood pressure control, and cholesterol management can significantly reduce cardiovascular risks during ADT.
Conclusion

When asking which type of prostate cancer ADT is safer for the heart, current evidence points toward GnRH antagonists as potentially having a lower cardiovascular risk, particularly for men with existing heart disease. However, treatment decisions should always be personalised. Open communication between patients, oncologists, and cardiologists is essential to ensure both effective cancer control and long-term heart health.