Avirup Guha, Director of Cardio-Oncology at Georgia Cancer Center, shared on LinkedIn:
“How should cardio-oncology be organized around prostate cancer?
RADICAL PC-2 provides the strongest randomized evidence yet. Its central message is organizational: assess cardiovascular risk in every patient, but do not make a specialist consultation obligatory for every man starting ADT.
I am proud to be a coauthor and RADICAL PC-2 Steering Committee member. This pragmatic trial enrolled 2,487 men with recently diagnosed prostate cancer or first ADT exposure across 55 sites in 8 countries.
Routine cardiology/internal-medicine referral added to usual care:
- structured statin,
- blood-pressure treatment,
- smoking cessation,
- diet and exercise support.
Over a median 5.8 years, the powered hierarchical outcome favored referral (win ratio 1.60; 95% CI 1.42-1.81). But the hierarchy matters: cholesterol control produced 99.4% of net wins. The nonpowered clinical composite of cardiovascular death, MI, stroke or heart failure was not reduced (sHR 1.08; 95% CI 0.79-1.49). With only 171 events-fewer than expected-this is no demonstrated hard-event benefit, not proof of no benefit or harm.
The prespecified companion subgroup analysis was exploratory, nonpowered and not adjusted for multiplicity. More favorable signals appeared with total cholesterol >4 mmol/L and, for clinical events, BP ≥130/80 or known hypertension; diabetes was directional only. None of these higher-risk strata independently showed a significant event reduction.
My practice takeaway:
- Assess BP, lipids, diabetes, smoking and lifestyle universally in prostate cancer care.
- Build reliable treatment pathways in oncology and primary care.
- Target cardiology/internal-medicine referral to uncontrolled risk, known cardiovascular disease or symptoms, diagnostic uncertainty, and complexity.
RADICAL PC-2 is not an argument to do less cardiovascular prevention. It is an argument to organize it better: universal cardiovascular responsibility, targeted specialist escalation.
Congratulations to Pinthus Jehonathan, Darryl Leong and the entire RADICAL PC team-and thank you to the participating patients and sites.
Title: Specialist Referral for Cardiovascular Risk in Patients With Prostate Cancer
Authors: Darryl Leong, Celestia Higano, Cristina Cano Garcia, Vincent Fradet, D. Robert Siemens, Tamim Niazi, Bobby Shayegan, Avirup Guha, Filipe Cirne, Joseph Selvanayagam, Philippe Violette, Felipe Valle, Luke Lavallée, Emmanuelle Duceppe, Patrick Anderson, Denis Xavier, Jose Patricio Lopez-Lopez, Nicolas Villareal Trujillo, Ariel Galapo Kann, Rafaela Piccoli, Marina Mourtzakis, David Sarid, Srivatsa Narasimha, Patrick Luke, Ludhmila Hajjar, Himu Lukka, Laurence Klotz, Kumar Balasubramanian, Rajibul Mian, Steven Agapay, Sumathy Rangarajan, Sarah Karampatos, Kelvin Ng, Alvaro Avezum, P. J. Devereaux, Jehonathan Pinthus
Avirup Guha was recognized among OncoDaily’s ‘100 Xfluencers in Prostate Cancer: Key Opinion Leaders to follow on X (Twitter) in 2025‘, highlighting their contributions to the field of oncology.
Nominations for ‘100 Influential People in Oncology 2026’ are now open, recognizing leaders, researchers, clinicians, innovators, advocates, and other individuals making a meaningful impact on oncology and cancer care.
Don’t miss the opportunity to nominate yourself, a colleague, or someone whose contributions deserve to be recognized.
Submit Your Nomination by September 15.
