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CUA GUIDELINE
ORIGINAL RESEARCH
UPDATE – Canadian Urological Association guideline on androgen
deprivation therapy: Adverse events and management strategies
Summary of changes
Andrea Kokorovic , Alan I. So , Hosam Serag , Christopher French , Robert J. Hamilton , Jason P. Izard ,
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Jasmir G. Nayak , Frédéric Pouliot , Fred Saad , Bobby Shayegan , Armen Aprikian , Ricardo A. Rendon 10
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1 Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada; Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada; Division of Urology, Department of Surgery,
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Memorial University, St. John’s, NL, Canada; Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada; Department of Urology, Queen’s University, Kingston, ON,
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Canada; Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada; CHU de Quebec, Université Laval, Quebec, QC, Canada; Division of Urology, Departments of Surgery
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and Oncology, McMaster University, Hamilton, ON, Canada; McGill University Health Centre, Montreal, QC, Canada; Department of Urology, Dalhousie, University, Halifax, NS, Canada
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Cite as: Kokorovic A, So AI, Serag H, et al. UPDATE – Canadian Urological Association guideline on 2. The statement, “In patients with a history of MI or stroke,
androgen deprivation therapy: Adverse events and management strategies – Summary of changes. referral to a cardiologist or cardio-oncologist may be con-
Can Urol Assoc J 2022;16(8):243-4. http://dx.doi.org/10.5489/cuaj.8007 sidered for assessment and medical optimization prior to
initiating ADT (Expert opinion),” has been modified to:
- Patients with a history of MI or stroke should be
Full-text guideline update available at cuaj.ca and cua.org referred to a cardiologist or cardio-oncologist for
assessment and medical optimization at the time
ue to the recent release of data from the PRONOUNCE of initiating ADT (Expert opinion).
trial, authors of the Canadian Urological Association 3. The following statement has been added:
D(CUA) guideline on androgen deprivation therapy - All patients receiving ADT should undergo a base-
(ADT) felt updates to the 2021 document were warranted. A line cardiovascular risk assessment and be mon-
summary of changes is included herein. The full draft of the itored for cardiovascular complications while
guideline, with revisions, can be viewed at cuaj.ca or cua.org. receiving therapy (Expert opinion).
*** Rationale
The CUA guideline on ADT was published in June 2021 in
Summary of changes an effort to highlight adverse events associated with therapy,
and, importantly, strategies to mitigate these events. The
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The PRONOUNCE trial failed to demonstrate a meaningful guideline panel strongly recommends that a multidisciplin-
difference in cardiovascular disease (CVD) risk between ary approach be used to decrease the risk of cardiovascular
gonadotropin-releasing hormone (GnRH) agonists and events in men receiving ADT. Emphasis is placed on the opti-
antagonists. It remains important for physicians to iden- mization of cardiometabolic parameters through the primary
tify patients at high risk for major adverse cardiac events care provider or cardio-oncologist, particularly in high-risk
(MACE) so that these men receive cardiac optimization men with a prior history of MACE. An important and con-
while undergoing cancer treatment. A systematic baseline troversial question is whether there is a difference in adverse
cardiovascular risk assessment is important before initiating cardiovascular outcomes in men receiving a GnRH agonist or
cancer therapies. antagonist, particularly in those with a prior history of MACE.
Based on results of the PRONOUNCE study, the ADT The guideline panel recommends that a GnRH antagonist
guideline panel has made the following changes to their may be considered in these men to potentially decrease the
recommendations: risk of cardiovascular complications, albeit based on limited
1. The following statement has been removed: data. These recommendations were made before the results
- Use of a GnRH antagonist may be considered in of PRONOUNCE — a trial comparing cardiovascular safety
men with a prior history of myocardial infarction of degarelix vs. leuprolide in patients with advanced prostate
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(MI) or stroke (LE 2, weak recommendation). cancer and cardiovascular disease — were published.
CUAJ • August 2022 • Volume 16, Issue 8 243
© 2022 Canadian Urological Association