Prostate cancer is the most common male cancer in the United States, with an estimated 299,000 new cases in the United States in 2024, representing nearly 15% of all new cancers.
Rana R. McKay, M.D.
Professor of Medicine and Urology, UC San Diego Moores Cancer Center, Member of the National Comprehensive Cancer Network® (NCCN®) Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Prostate Cancer (2020-2024)
Of the 299,000 estimated new cases of prostate cancer this year, more than 40% of patients are likely to receive androgen deprivation therapy (ADT), a type of hormone therapy, at some point during their treatment. People undergoing treatment for prostate cancer and their caregivers need to understand how both cancer and treatment may put their bone and heart health at risk, and how discussion of risks and options with their healthcare team could substantially improve quality of life.
Bone health concerns
Prostate cancer treatments — particularly hormone therapies like ADT, which is typically given to those with more aggressive or advanced disease — can decrease bone density. This can result in a higher risk for osteoporosis (low bone density) and fractures.
The NCCN Guidelines® for Prostate Cancer emphasize the importance of monitoring and managing bone health during prostate cancer treatment through bone density assessments, including consideration for baseline bone density testing before starting ADT. Some patients may benefit from bone-strengthening medicines. There are also lifestyle changes that can reduce the risk of fractures and other bone problems, including a diet rich in calcium and vitamin D, weight-bearing exercises, weight loss, and balance training.
People being treated for prostate cancer should ask their doctor:
- Should my bone density be tested at the start of and during treatment?
- Are there medications I can take to protect my bone health?
- What dietary changes or supplements might help maintain my bone strength?
- What types of exercise are recommended to improve or maintain bone strength?
Heart health concerns
Up to 90% of patients with prostate cancer may already have risk factors of heart or vascular disease, also known as cardiovascular disease or CVD, before treatment. ADT and other hormonal treatments could further increase the risk of cardiovascular events, such as heart attacks and strokes. Cardiovascular disease risk factors can often be addressed through monitoring, lifestyle changes, and medications.
The NCCN Guidelines for Survivorship recommend following the ABCDEs of heart wellness in cancer survivors:
- A —Awareness of the risk factors and symptoms of heart disease; Assessment of being at risk for or having heart disease; Aspirin if needed
- B — Blood pressure management
- C — Cholesterol management; Cigarettes and other tobacco products are not used
- D — Diet and weight management; Doses of anthracyclines and chest radiation are considered; Diabetes prevention and treatment
- E— Exercise; Echocardiogram, electrocardiogram, or both, if needed
The NCCN Guidelines recommend that doctors engage in a multidisciplinary approach to prostate cancer treatment that includes not only oncologists, but also cardiologists, endocrinologists, and primary care providers.
It is crucial that patients and caregivers are informed about every aspect of their care, including potential short- and long-term side effects, in order to chart a care plan that best reflects their choices and priorities. This is particularly true when it comes to bone and heart health for people with prostate cancer but applies to all people with cancer. Everyone should be empowered to learn more about how to minimize their risks and enhance their overall well-being.
The NCCN Guidelines for Patients® is a free resource based on the NCCN Guidelines used by clinicians — the evidence-based expert consensus-driven recommendations that providers rely on to stay up to date on high-quality cancer care worldwide. There are separate books for nearly every type of cancer, including early-stage and advanced-stage prostate cancer, as well as prevention, screening, and supportive care topics such as long-term survivorship. They are free to view and download, through funding from the NCCN Foundation®, at NCCN.org/patients.
