Prognostic impact of coronary calcifications in patients with recently diagnosed prostate cancer.

Abstract

Background: Patients with prostate cancer are at increased risk of cardiovascular events. A non-electrocardiogram gated CT scan of the thorax is part of the diagnostic workup, allowing for assessment of coronary calcifications. However, the prognostic impact of a coronary artery calcium score (CACS) obtained from such CT scans is uncertain.

Objectives: To investigate the association between CACS and a combined endpoint of all-cause death, myocardial infarction, or stroke in patients with recently diagnosed prostate cancer.

Methods: The primary analysis included patients (N=571) with recently diagnosed prostate cancer and without known coronary artery disease undergoing prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT). Patients were stratified into four CACS groups. Cox proportional hazard models adjusted for risk factors were used to examine the association between CACS and the combined endpoint.

Results: Patients were distributed in the four CACS groups as follows: CACS 0-10 (26%), 11-99 (21%), 100-399 (24%) and ≥400 (29%). An increased risk of the combined endpoint was found with increasing CACS. Compared with CACS 0-10, the hazard ratios for CACS 11-99, 100-399 and ≥400 were 0.95 (95% CI: 0.37-2.42), 2.39 (95% CI: 1.13-5.09) and 3.14 (95% CI: 1.52-6.48), respectively. Only 53% of patients in the CACS ≥400 group received statins.

Conclusion: In patients with prostate cancer, assessment of a CACS from the initial PET/CT scan allows for the identification of patients with a threefold higher risk of death, myocardial infarction, or stroke. Initiation of preventive statin treatment in these patients could reduce cardiovascular events.