Expert consensus provides guidelines for managing cardiometabolic risk in patients with prostate cancer on ADTExperts Establish Guidelines for Heart Health in Prostate Cancer Patients

Prostate cancer is one of the most diagnosed malignancies among men globally, with androgen deprivation therapy (ADT) and androgen receptor-targeted therapy remaining central to the management of advanced disease. Despite their proven efficacy in controlling tumour progression, these therapies are associated with significant cardiovascular and metabolic risks. The authors aimed to develop a set of evidence-based recommendations for the assessment, monitoring, and management of cardiometabolic risks associated with ADT and androgen receptor-targeted therapy in patients with prostate cancer. A panel of 12 clinicians from Malaysia and Singapore, with expertise in prostate cancer and cardiovascular disease management, developed consensus statements using a modified Delphi method. Statements were informed by a literature review and refined through structured discussions and anonymous voting until consensus was achieved. A total of 13 statements were developed, of which 12 achieved consensus. Key recommendations include conducting a baseline evaluation of lifestyle risk factors and comorbidities, implementing a simplified cardiovascular disease risk assessment checklist, and tailoring treatment plans and structured management protocols according to individual cardiovascular disease risk categories. The panel also recommended referring high-risk or symptomatic patients for appropriate care (if not already on follow-up) and initiating cardiometabolic monitoring post-treatment with frequency adjusted based on patient-specific risk profiles. Additional endorsed strategies included incorporating lifestyle modification counselling during follow-up, applying the modified ABCDE Cardio-Oncology framework, and involving multidisciplinary teams in managing patients with elevated cardiovascular risk. The rejected statement, which proposed routine baseline electrocardiograms for all patients, lacked support owing to limited evidence, logistical and interpretative challenges, and concerns over delaying cancer treatment. This consensus document offers practical, evidence-based guidance for minimising cardiometabolic risks in patients with prostate cancer on ADT or androgen receptor-targeted therapy. These recommendations support individualised care, balancing oncological efficacy with cardiovascular safety to improve patient outcomes.