Prostate cancer referrals improve cholesterol, not heart outcomes

At the European Society of Cardiology Congress on Aug. 30, 2026, Darryl Leong presented a result that split the difference between better prevention and fewer crises: in 2,501 men with prostate cancer, adding a cardiologist or internist to usual cancer care improved cholesterol management but did not significantly reduce heart attacks, strokes, heart failure or cardiovascular deaths.

The RADICAL PC 2 trial enrolled men across eight countries between 2015 and 2025. They either had newly diagnosed prostate cancer or were beginning androgen deprivation therapy (ADT), a hormone treatment that can increase the risk of diabetes, high blood pressure and heart disease. Participants were randomly assigned to usual care alone or usual care plus a referral to a cardiovascular specialist.

The specialist pathway produced clear changes in treatment. Statin use reached 63%, compared with 40% with usual care, while blood-pressure medication reached 56%, compared with 49%. The referred group also had significantly lower cholesterol levels over time. Specialists were asked to provide advice on diet and exercise, help patients quit smoking, prescribe a statin regardless of existing cholesterol levels and add blood-pressure medication when pressure was above the target of 130 mmHg.

The harder endpoint did not move. After nearly six years of follow-up, researchers found no significant difference between the groups in cardiovascular death, heart attack, stroke or heart failure. Leong said a possible reduction in heart attacks was visible in the data, but that signal still needs confirmation; fewer cardiovascular complications than expected also made the trial less able to detect an effect.

So what changes in practice? Not every man with prostate cancer necessarily needs a routine cardiovascular referral, but heart-risk checks should not disappear behind the cancer diagnosis. An accompanying analysis in JACC CardioOncology identified men with blood pressure above 130/80, diabetes or cholesterol above 4 mmol/L as the patients most likely to benefit. The figures come from the trial team, and the absence of a significant reduction in major cardiovascular outcomes limits what can be claimed today.