PET/CT scans used to visualize findings in men with recurrent prostate cancer may also help assess their risk for cardiovascular disease, according to a study published January 22 in Clinical Genitourinary Cancer.
In an analysis of imaging among 354 patients, incidental coronary calcification on PET/CT was associated with an increased risk of major adverse cardiovascular events (MACE), according to lead author Preet Shaikh, MD, of Washington University School of Medicine in St. Louis, MO, and colleagues.
“Cardiovascular disease (CV) is common among men with prostate cancer and the leading cause of death in this population. There is a need for CV risk assessment tools that can be easily implemented in the prostate cancer treatment setting,” the group wrote.
Coronary arterial calcification is a known predictor of adverse cardiovascular events in the general population. Typically, dedicated cardiac CT scans are used to identify it, with findings reported as coronary artery calcium scores.
Recently, small studies have shown that incidental coronary arterial calcification estimated from the CT portion of PET/CT scans may also have prognostic significance, the authors noted. However, whether these findings have predictive value in men with prostate cancer is unknown, they added.
To elucidate this, the researchers identified 354 men with prostate cancer who underwent PET/CT at their institution from 2012 to 2017. They culled clinical data and coronary calcification findings from the PET/CT imaging and analyzed their associations with heart attack, coronary or peripheral revascularization, stroke, heart failure hospitalization, or all-cause mortality occurring within five years.
Among the patients, there were 98 MACE events in 74 patients (21%). All-cause mortality was the most common MACE event (35%), followed by coronary revascularization/myocardial infarction (26%) and stroke (19%), the authors wrote.
According to the analysis, after adjusting for age and diabetes among the patients, incidental coronary calcification on baseline PET/CT was significantly associated with risk of MACE (hazard ratio [HR], 1.9).
In addition, in comparison, the researchers calculated the Framingham risk score (a validated means of predicting CV disease risk) in 54% of the patients using all available clinical and laboratory data. In this subgroup, they found high Framingham risk scores were not associated with MACE.
“Among 354 men with recurrent prostate cancer undergoing PET/CT at a single institution, incidental coronary calcification was associated with major adverse CV events with greater feasibility than the Framingham risk score,” the group wrote.
Ultimately, current prostate cancer practice guidelines recognize the need for cardiovascular assessment and surveillance in men with prostate cancer, particularly those receiving androgen deprivation therapy [ADT], the researchers noted.
The National Comprehensive Cancer Network's Clinical Practice Guidelines For Prostate Cancer recommend “screening for and intervention to prevent/treat diabetes and CVD in men receiving ADT,” for instance, yet particular tools and cutoffs for cardiovascular screening and intervention are not specified, the authors wrote.
“To our knowledge, this is the first study to evaluate the predictive utility of a cardiovascular risk stratification tool specifically in men with prostate cancer,” the group concluded.
The full article is available here.
