Indian Delphi consensus on cardiovascular risk mitigation in prostate cancer management

Prostate cancer (PCa) is one of the most common cancers affecting men worldwide and its prevalence is rising in India. The disease primarily affects older men, with incidence increasing with age, and a substantial proportion present with advanced or metastatic disease at diagnosis. Simultaneously, cardiovascular disease (CVD) remains highly prevalent in the Indian population, representing a major cause of non-cancer mortality. The intersection of PCa, its treatment, and cardiovascular comorbidities presents a complex clinical challenge, particularly as therapies such as androgen deprivation therapy (ADT) and androgen receptor pathway inhibitors (ARPIs) improve overall survival but carry cardiometabolic risks.

The Prostate Cancer Cardiovascular (PCCV) Risk Expert Panel, consisting of urologists, oncologists, and cardio-oncologists from India with guidance from an international expert, developed practical, India-specific recommendations using a modified Delphi methodology. Evidence on the cardiovascular effects of ADT and ARPIs was reviewed and contextualized for Indian clinical practice. Consensus was defined as ≥75% agreement among panelists.

The panel recommended comprehensive baseline lifestyle and cardiometabolic assessment, use of simplified cardiovascular risk checklists, baseline ECG and metabolic profiling, and risk stratification into low, intermediate, or high cardiovascular risk. GnRH antagonists were preferred for high-risk patients, with referral to cardiologists for those at intermediate or high risk. Ongoing cardiometabolic monitoring, lifestyle interventions, and integration of the ABCDE (A - Awareness and Aspirin: Identify risk factors and consider prophylactic aspirin if appropriate, B - Blood Pressure: Monitor and manage hypertension, C - Cholesterol/Cigarettes: Manage cholesterol and avoid smoking, D - Diet/Diabetes: Promote a heart-healthy diet and control blood sugar, E - Exercise: Encourage regular physical activity). Cardio-Oncology framework were emphasized. A multidisciplinary care model involving oncologists, urologists, cardiologists, and primary care providers was strongly recommended.

With increasing use of ADT and ARPIs and the high burden of cardiovascular comorbidities in Indian men with PCa, proactive cardiovascular risk assessment, individualized treatment selection, and coordinated multidisciplinary management are essential. This expert consensus provides actionable, India-specific guidance to balance oncologic efficacy with cardiovascular safety and improve long-term outcomes and quality of life for patients.