Avirup Guha, Director of Cardio-Oncology at Georgia Most cancers Middle, shared on X:
“RADICAL PC-2 offers the strongest randomized proof but for organizing cardio oncology round prostate most cancers: assess CV threat in everybody – however don’t refer each man beginning ADT to a specialist. New at ESC2026.
Pragmatic RCT: 2,487 males with not too long ago identified prostate most cancers or first ADT publicity; 55 websites, 8 international locations. Referral to cardiology/inside drugs added statin/BP remedy, smoking cessation, weight-reduction plan and train to common care.
Median follow-up: 5.8 years. PHRI.ca Inhabitants Well being Analysis Institute. We recruited round 180 of them.
The powered hierarchical consequence favored referral: Win ratio 1.60 (95% CI 1.42–1.81; P<.001). The hierarchy was CV loss of life → MI → stroke → HF → complete ldl cholesterol >155 mg/dL (4 mmol/L) → SBP >130 mm Hg.
Vital: A win ratio of 1.60 isn’t a 60% occasion discount.
Ldl cholesterol management generated 99.4% of internet wins; BP −0.9%. Complete ldl cholesterol was 12 mg/dL decrease; close-out statin use was 63% vs 40%. This was mainly a risk-factor-control consequence.
The nonpowered co-primary medical composite – CV loss of life/MI/stroke/HF – was not lowered: sHR 1.08 (95% CI 0.79–1.49; P=.62). Solely 171 sufferers (6.9%) had an occasion.
So: no demonstrated hard-event profit, not proof of no profit.
Uptake was pragmatic and imperfect: 90% vs 21% noticed a specialist; close-out antihypertensive use was 56% vs 49%. Crossovers, nonadherence and fewer occasions than anticipated restricted energy for clinical-event variations.
Prespecified subgroup indicators: complete ldl cholesterol >4 vs ≤4 mmol/L had win ratios 1.75 vs 1.21 (P-int=.016). Scientific-event estimates have been extra favorable with BP ≥130/80 or recognized HTN, and directionally with diabetes.
Caveat: exploratory, nonpowered and never multiplicity-adjusted. None of these higher-risk strata independently confirmed important clinical-event discount. These are hypotheses – and markers of room for risk-factor enchancment – not proof.
Follow takeaway: assess BP, lipids, diabetes, smoking and way of life universally in prostate most cancers care. Construct remedy pathways; refer selectively for uncontrolled threat, recognized CVD/signs, diagnostic uncertainty or complexity.
Hope everybody within the room with Darryl Leong had a good time and congrats to the complete RADICAL PC group for the superb trial and due to sufferers who helped us get insights to assist the following era!”
Title 1: Specialist Referral for Cardiovascular Threat in Sufferers With Prostate Most cancers: A Randomized Scientific Trial
Authors: Darryl P. Leong, Celestia Higano, Cristina Cano Garcia, Vincent Fradet, D. Robert Siemens, Tamim Niazi, Bobby Shayegan, Avirup Guha, Filipe Cirne, Joseph B. Selvanayagam, Philippe D. Violette, Felipe H. Valle, Luke T. Lavallée, Emmanuelle Duceppe, Patrick Anderson, Denis Xavier, Jose Patricio Lopez-Lopez, Nicolas Villareal Trujillo, Ariel Galapo Kann, Rafaela Ok. Piccoli, Marina Mourtzakis, David Sarid, Srivatsa Narasimha, Patrick P.P.W. Luke, Ludhmila A. Hajjar, Himu Lukka, Laurence Klotz, Kumar Balasubramanian, Rajibul Mian, Steven Agapay, Sumathy Rangarajan, Sarah Karampatos, Kelvin Ok. H. Ng, Alvaro Avezum, P. J. Devereaux, Jehonathan H. Pinthus for the RADICAL PC Investigators
Title 2: Figuring out Sufferers With Prostate Most cancers Who Profit Most From Routine Cardiovascular Specialist Referral
Authors: Cristina Cano Garcia, Jehonathan Pinthus, Alvaro Avezum, P.J. Devereaux, Laurence Klotz, Celestia Higano, Vincent Fradet, Joseph Selvanayagam, Avirup Guha, Ludhmila Hajjar, Jose Patricio Lopez-Lopez, Denis Xavier, Kelvin Ng, Sumathy Rangarajan, Sarah Karampatos, Steven Agapay, Rajibul Mian, Kumar Balasubramanian, Filipe Cirne, Melissa Huynh, Margot Ok. Davis, Robert J. Hamilton, Darin Gopaul, Som D. Mukherjee, Malik Farooqi, Alexander P. Benz, Rachel Richard, Chieh Yang Christopher Koo, Darryl P. Leong on behalf of the RADICAL PC Investigators
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