HAMILTON, Ont. - Men with prostate cancer have a high risk of heart disease, especially when treated with hormone therapy. A large international, first-of-its-kind study led by Hamilton researchers found that routine referrals to an internist or cardiologist improved cholesterol levels, but did not lead to fewer heart attacks, strokes, heart failure or cardiovascular deaths.
The findings were simultaneously published in JAMA Internal Medicine and presented at the European Society of Cardiology Congress on August 30, 2026, by Darryl Leong, the study's principal investigator and a senior scientist at the Population Health Research Institute (PHRI), a joint institute of Hamilton Health Sciences and McMaster University.
Researchers aimed to explore whether involving a cardiologist or internist in the care of prostate cancer patients could improve management of cardiovascular risk factors and reduce serious heart-related complications.
After nearly six years of follow-up, participants referred to a cardiologist or internist in addition to usual prostate cancer care were significantly more likely to receive statin therapy (63 per cent versus 40 per cent) and blood pressure medication (56 per cent versus 49 per cent) than those receiving usual care alone. Over time, the referred group also had significantly lower cholesterol levels.
Despite these improvements, there was no significant difference between the groups in cardiovascular death, heart attack, stroke or heart failure during follow-up. Researchers noted that fewer participants experienced these complications than expected, making it harder to determine whether the referral strategy affected those outcomes.
"I was surprised that we didn't see a reduction in heart attacks, strokes, heart failure or cardiovascular death in the group referred to a specialist," said Leong, director of the McMaster University and HHS Cardio-Oncology Program, HHS cardiologist, and an associate professor with McMaster's Department of Medicine.
"However, looking closely at the data, there is a signal suggesting a reduction in heart attacks, which is consistent with the cholesterol-lowering effect we observed. That finding needs to be confirmed through further research."
Androgen deprivation therapy (ADT), a common prostate cancer treatment, can increase the risk of diabetes, high blood pressure and heart disease. While clinical guidelines recommend monitoring and managing these risks, there has been little evidence on whether adding cardiovascular care to prostate cancer treatment would improves outcomes for patients.
"When someone is diagnosed with prostate cancer, the focus is often on the cancer. But heart health is important too, especially for patients receiving hormone therapy," said Leong. "We wanted to understand whether involving a cardiovascular specialist could help patients manage risk factors like cholesterol, blood pressure and diabetes, follow healthier habits and lifestyle, and eventually improve their health."
The RADICAL PC 2 trial enrolled 2,501 participants from eight countries (Canada, Brazil, Singapore, Colombia, India, Australia, Israel and the United States) from 2015 to 2025. Participants were men with newly diagnosed prostate cancer or those who were beginning ADT for the first time.
The participants in this study were randomly assigned to one of two groups: the first group received their usual cancer care, and the second one received usual care in addition to referral to an internist or cardiologist, who was asked to provide:
- Personalized advice on healthy eating and exercise
- Guidance on quitting smoking
- A cholesterol-lowering medication (statin), regardless of existing cholesterol levels
- Blood pressure medication, if blood pressure was above target (130 mmHg)
While routine referral to a cardiovascular specialist may not be necessary for every prostate cancer patient, some men are more likely to benefit than others.
An accompanying study published simultaneously in JACC CardioOncology identified patients most likely to benefit from referral to a cardiovascular specialist. Men with blood pressure above 130/80, diabetes or cholesterol above 4 mmol/L were found to be most likely to benefit.
Researchers say the findings highlight the importance of ensuring cardiovascular risk factors are addressed as part of routine prostate cancer care.
"Cardiovascular risk factors like high cholesterol, high blood pressure, diabetes and smoking are often poorly addressed in patients with prostate cancer," added Leong. "I
hope these findings raise awareness of heart disease risk among both prostate cancer patients and their healthcare providers; and help doctors make smarter decisions about how we care for these patients so that conditions like high cholesterol, high blood pressure and diabetes don't get lost in the focus on cancer treatment."
Leong encourages prostate cancer patients to ask questions about their heart health.
"If you have prostate cancer, ask your healthcare provider what your blood pressure, cholesterol and blood sugar levels are, and whether they need to be better controlled. Taking care of your heart health is an important part of your cancer care."
This study was supported by the Movember Foundation/ Prostate Cancer Canada, Hamilton Health Sciences Research Strategic Initiative, the Canadian Cancer Society/ Canadian Institutes of Health Research, Tolmar Pharmaceuticals, and PHRI.
