Heart Failure Induced by Darolutamide in an Older Patient With M0 Castration-Resistant Prostate Cancer: A Case Report

Androgen receptor signaling inhibitors (ARSIs) improve survival in prostate cancer; however, it may increase cardiovascular risks, especially in elderly patients with heart disease.

A 94-year-old man with aortic valve stenosis, hypertension, and diabetes had a nodal metastatic progression of prostate cancer at 88 years of age, leading to the implementation of androgen deprivation therapy (ADT). After 5 years of therapy, prostate-specific antigen (PSA) re-elevated; however, ADT was maintained. At 94 years old, darolutamide was started due to worsening of urinary symptoms. Although these symptoms improved, the patient developed a heart failure with elevated B-type natriuretic peptide (BNP). Darolutamide was discontinued, leading to reduced BNP levels but increased PSA levels. A reduced dose (300 mg/day) resulted in stable PSA levels without BNP elevation.

Careful cardiovascular monitoring is crucial when ARSIs are used in older patients with heart disease. Dose adjustments may help balance oncological benefits and cardiac safety.