Cardiovascular disease and diagnosis of advanced prostate cancer

Cardiovascular disease (CVD) and cancer are the two leading causes of death in the US. Preclinical models support a direct effect of cardiovascular disease (CVD) on accelerated cancer growth and spread. Our objective is to test the hypothesis that individuals with prevalent CVD are at an increased risk of presenting with more advanced prostate cancer at diagnosis.

We conducted a case-control study in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked databases from 2010-2019. The analysis was undertaken from October 2024 to February 2025. We included male individuals aged ≥ 67 years diagnosed with invasive prostate cancer with at least two healthcare interactions and evidence of PSA screening in the 3 to 24 months prior to cancer diagnosis. Our exposure of interest was CVD in the 3 to 24 months prior to cancer diagnosis. Our a priori hypothesis tested the odds of prevalent CVD in patients with localized (T1-2 and N0 and M0) versus advanced (T3-4 or N + or M +) prostate cancer at diagnosis.

Our analysis included 12,120 matched individuals, with median age 75 years (interquartile range 71-80), of which 88% were white, 8% were black, and 59% had prevalent CVD. Multivariable adjusted models demonstrated that individuals with advanced prostate cancer at diagnosis had a statistically significant 10% increased odds of prevalent CVD (OR, 1.10; 95% CI, 1.00-1.22; p = 0.047). This finding was strongest when examining individuals with regional or distant spread at diagnosis (N + or M + ; OR, 1.19; 95% CI, 1.05-1.34; p = 0.006). Further, individuals with Gleason score ≥ 8 disease at diagnosis, had an increased odds of prevalent CVD (OR, 1.07; 95% CI, 1.01-1.13; p = 0.020).

We demonstrate an association between prevalent CVD and advanced prostate cancer at diagnosis. Our results may help guide patients regarding personalized screening decisions, given current guidelines recommending shared decision-making, and can be used to facilitate targeted screening approaches.