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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
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