Abstract: TH-PO0212
A Balancing Act: Prostate Cancer, Antiandrogen Therapy, and Cardiovascular Disease
Session Information
- Onconephrology: Anticancer Therapies, PTLD, Paraneoplastic Diseases, and More
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Churilla, Bryce M, Emory University School of Medicine, Atlanta, Georgia, United States
- Amarapurkar, Pooja D., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Introduction
Cardiovascular disease (CV) and prostate cancer (PCa) are common co-existing comorbidities particularly in older men with a 50% increased risk of CV-related mortality for age matched controls without PCa. Several therapies used in treating PCa have adverse cardiovascular effects such as hypertension (HTN) and heart failure. Notably, androgen synthesis inhibitors such as abiraterone, a cornerstone in the management of advanced metastatic prostate cancer, have been associated with significant CV toxicities particularly HTN.
Case Description
A 70-year-old male with no comorbidities and high risk, localized PCa was initially treated with Bicalutamide followed by radiation. Three years later due to recurrence abiraterone and prednisone was initiated. Three months after treatment initiation, he developed difficult to control blood pressure (BP) (140-170/66-88 mmHg). BP was refractory to five anti-HTN medications (amlodipine, hydralazine, eplerenone, clonidine, indapamide), which were added over time at tolerated doses. Given the lack of BP control and stable prostate specific antigen, the abiraterone/prednisone therapy was held. Several weeks after stopping therapy, BP became controlled on only three anti-HTN agents. The decision was made to monitor disease activity while off therapy.
Discussion
This case highlights emerging challenges in Onconephrology-severe resistant hypertension due to Abiraterone needing theray discontinuation. Abiraterone inhibits 17α-hydroxylase and 17,20-lyase reducing androgen synthesis and causes a mineralocorticoid excess state- hypertension, hypokalemia, fluid overload. Co-administration of prednisone may decrease the severity, seemingly reducing ACTH overproduction. Mineralocorticoid receptor antagonists may interfere with Abiraterone's mechanism of action, limiting their role in treating HTN. Thus Timely recognition of PCa therapy-related side effects is essential to minimize cardiovascular mortality and prevent treatment disruption.