In 2022, GLOBOCAN (Global Cancer Observatory) reported 1 467 854 new cases of prostate cancer [age-standardised rate (ASR): 29.4 per 100 000 individuals], 397 430 prostate cancer-related deaths (ASR: 7.3 per 100 000). Androgen deprivation therapies (ADTs) that target androgen/androgen receptor (AR)-mediated signalling pathways are the first-line therapeutic option for advanced prostate cancer. Growing evidence highlights differences in cardiovascular risk between these therapies, with GnRH agonists being associated with a higher likelihood of cardiovascular events compared to GnRH antagonists. This consensus paper aims to establish region-specific recommendations for assessing and managing cardiovascular risk in PCa patients in Singapore and Malaysia, using a modified Delphi methodology involving a panel of 12 experts in oncology, cardiology, and urology.

A two-round modified Delphi process was conducted with 12 multidisciplinary experts from Singapore and Malaysia. The panel reviewed existing literature, assessed cardiovascular risk factors in PCa patients, and evaluated current risk models. 13 key statements were included for the discussion. Consensus was defined as ≥75% agreement on key statements. Final recommendations were developed to guide clinical decision-making.

The expert panel reached consensus on 12 out of 13 statements. The expert agreed on the need for simplified CVD risk assessment checklist for all patients to categorize their CVD risk before treatment with a structured management protocol to optimize patient care. For patients with significant pre-existing CVD, GnRH antagonists can be considered over GnRH agonists and surgical castration. The follow up management includes cardio-metabolic monitoring, lifestyle modification counseling and the use of modified ABCDE clinical framework.

Given the increased cardiovascular burden associated with ADT or AR-targeted therapy, integrating risk assessment, proactive monitoring, and multidisciplinary collaboration into routine care plans is essential. A structured framework for CVD risk stratification and mitigation should ideally facilitate tailored intervention, including early cardiology referral, lifestyle modification, and treatment adjustment, to balance oncological efficacy with cardiovascular safety.