Coronary Microvascular Dysfunction in Men with Prostate Cancer Receiving Androgen-Deprivation Therapy

Abstract

IntroductionMethods to quantify cardiovascular (CV) risk and inform cardioprotective strategies are needed for prostate cancer patients initiating androgen deprivation therapy (ADT). In addition to determining epicardial coronary artery stenosis, myocardial perfusion PET stress imaging can detect coronary microvascular dysfunction (CMD), a validated predictor of major adverse CV outcomes, by quantifying myocardial blood flow reserve (MBFR). However, the utility of MBFR as an indicator of adverse CV outcomes in patients initiating ADT is poorly understood. Patients and MethodsWe prospectively obtained myocardial perfusion PET imaging in 15 prostate cancer patients within 3 weeks of ADT initiation and following 6 months of ADT exposure. MBFR was quantified and used to determine CMD. ResultsOne patient (7.7%) had reduced MBFR at baseline, and 5 additional patients (46.2%) developed reduced MBFR within 6 months of ADT initiation (p = 0.025). While no patients had CMD at baseline, 3 patients (30%) developed incident CMD following ADT initiation (p = 0.083). ConclusionMyocardial perfusion PET imaging demonstrated a high incidence of reduced MBFR and CMD within 6 months of ADT initiation. These findings highlight changes in measures of subclinical CV disease that occur early with ADT and motivate further studies to inform CV risk in this population.