Cardiologist Referrals Lower Cholesterol in Men Starting ADT

What Happened

A large international study reported that routine referrals to an internist or cardiologist improved cholesterol levels in men with prostate cancer, particularly those receiving hormone therapy.

The same study found no significant difference in cardiovascular death, heart attack, stroke, or heart failure between referral and usual-care groups during follow-up.

What The Evidence Shows In This Study

The evidence comes from the RADICAL PC 2 trial, which randomly assigned prostate cancer patients to usual cancer care alone or usual care plus a referral to an internist or cardiologist.

The trial enrolled 2,501 participants from eight countries between 2015 and 2025, and followed participants for nearly six years. The participants were men with newly diagnosed prostate cancer or those beginning androgen deprivation therapy (ADT) for the first time.

• Compared with usual care alone, the referral group was more likely to receive statin therapy (63% vs 40%).
• The referral group was also more likely to receive blood pressure medication (56% vs 49%).
• Over time, the referral group had significantly lower cholesterol levels.
• There was no significant difference between groups in cardiovascular death, heart attack, stroke, or heart failure during follow-up.

Why This Matters For Metabolic Health During ADT

ADT is described in the report as a common prostate cancer treatment that can increase the risk of diabetes, high blood pressure, and heart disease, which are also tied to metabolic health.

In RADICAL PC 2, adding a cardiology or internal medicine referral increased use of cholesterol-lowering and blood pressure medications and was linked to lower cholesterol over time, even though major cardiovascular outcomes were not different between groups.

What The Referral Visit Was Asked To Do

In the referral arm, the internist or cardiologist was asked to provide counseling and risk-factor management alongside usual prostate cancer care.

The protocol described in the report included lifestyle guidance plus specific medication approaches for cholesterol and blood pressure.

• 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)

Limitations And What The Authors Flagged

The researchers reported that fewer participants had cardiovascular complications than expected, which made it harder to determine whether the referral strategy affected outcomes like heart attack or stroke.

The principal investigator said there was a “signal” suggesting a reduction in heart attacks consistent with the cholesterol-lowering effect, but noted that this would need confirmation in further research.