Heart attacks are the main cause of death in men diagnosed with prostate cancer (Circulation, Feb 4, 2016). More than 230,000 American men are newly diagnosed with prostate cancer each year. Because prostate cancer usually progresses so slowly, the more than three million living American men who are diagnosed with prostate cancer are at much higher risk for dying of heart attacks than they are of dying of their prostate cancer.

This is partly just statistics (heart attacks are the leading cause of death in men, and prostate cancer seldom kills), but patients also need to be told that some of the current treatments for prostate cancer can raise their risk for a heart attack. Doctors prescribe these treatments because they believe that the benefits outweigh any side effects they may cause.
1. Radiation increases risk for heart failure, irregular heartbeats and heart attacks. Women who receive radiation for breast cancer are also at increased risk for heart attacks (The Lancet, November 12, 2011;378(9804):1707-1716).
2. Chemotherapy drugs can damage the heart and peripheral blood vessels, increase risk for forming clots and raise blood cholesterol.
3. Giving drugs to block a man’s production of the male hormone, testosterone, to shrink prostate tumors increases risk for a heart attack in several ways (JAMA, Sept 22, 2015;314(12):1291 and British Journal of Urology International, March 2014). Blocking testosterone raises blood levels of the bad LDL cholesterol and triglycerides, increases body fat, decreases muscle and bone, raises blood sugar, increases insulin resistance, decreases sugar tolerance and increases risk for diabetes (Am J Clin Oncol, 35(5) 2012;504–509), all risk factors for heart attacks.

My Recommendations
If you are a man who is diagnosed with prostate cancer, you should work with your doctor to decide what treatments are best for you. All men with prostate cancer should be aware that they are far more likely to die from a heart attack than from prostate cancer. Men who adopt a more healthful lifestyle after being diagnosed with cancer are less likely to have that cancer recur (Journal of Clinical Oncology, Oct 20, 2012;30:3697-3704). Whether you choose “watchful waiting” or any of the available treatments, you should do everything possible to lower your heart attack risk. Follow ABCDE, the heart-attack-preventing mnemonic:
• Aspirin if indicated
• Blood pressure monitoring
• Cholesterol management and Cigarette avoidance
• Diet and Diabetes Prevention: eat lots of fruits and vegetables; restrict sugar-added foods and drinks, red meat and fried foods
• Exercise
Also keep blood levels of hydroxy Vitamin D above 20 ng/ml and lose excess fat if overweight.

Checked 3/20/18