Routine referrals of prostate cancer patients to cardiologists or internists improve cholesterol and blood pressure management but fail to reduce hard cardiovascular events like heart attacks or strokes, according to a large international trial presented on August 30, 2026.
Men facing a prostate cancer diagnosis confront elevated risks of heart disease, particularly when undergoing hormone therapies that can increase the risk of diabetes, high blood pressure, and cardiac conditions. To test whether specialized intervention changes those odds, researchers launched the RADICAL PC 2 trial, tracking participants across eight countries from 2015 to 2025.
RADICAL PC 2 Trial Tracks 2,501 Participants Across Eight Countries
The pragmatic randomized trial enrolled 2,501 participants in Canada, Brazil, Singapore, Colombia, India, Australia, Israel, and the United States. Researchers randomly assigned men with newly diagnosed prostate cancer or those beginning androgen deprivation therapy (ADT) into two distinct groups. One group received usual cancer care, while the second received usual care alongside a referral to an internist or cardiologist.
Specialists directed the second group to receive personalized advice on diet and exercise, smoking cessation guidance, and cholesterol-lowering statins regardless of baseline lipid levels. They also prescribed blood pressure medications whenever readings exceeded the target threshold of 130 mmHg.
“When someone is diagnosed with prostate cancer, the focus is often on the cancer. But heart health is important too, especially for patients receiving hormone therapy.”
Darryl Leong, director of the McMaster University and HHS Cardio-Oncology Program, HHS cardiologist, and associate professor, McMaster’s Department of Medicine
Improved Cholesterol and Medication Use Without Fewer Hard Cardiac Events
After a median follow-up approaching six years, participants referred to cardiovascular specialists achieved meaningful improvements in risk factor control. Patients in the specialist referral group were significantly more likely to receive statin therapy at 63 per cent compared to 40 per cent in the usual-care group. Antihypertensive medication use reached 56 per cent among referred patients versus 49 per cent for those receiving standard cancer care alone. Over time, the referred cohort also maintained significantly lower cholesterol levels.
Despite these clinical markers moving in a positive direction, the study found no statistically significant difference between the groups in cardiovascular death, heart attack, stroke, or heart failure. Investigators noted that fewer participants experienced these major adverse cardiac events than originally anticipated, which limited the statistical power needed to detect an effect on hard clinical endpoints.
“I was surprised that we didn’t see a reduction in heart attacks, strokes, heart failure or cardiovascular death in the group referred to a specialist.”
Darryl Leong, director of the McMaster University and HHS Cardio-Oncology Program, HHS cardiologist, and associate professor, McMaster’s Department of Medicine
At the same time, researchers spotted secondary signals in the data. According to trial discussions shared by Avirup Guha, Director of Cardio-Oncology at the Georgia Cancer Center, the trial’s powered hierarchical outcome favored referral with a win ratio of 1.60, driven overwhelmingly by cholesterol control rather than immediate drops in hard clinical events. Leong noted that a closer look at the data reveals a signal suggesting a reduction in heart attacks that aligns with the observed cholesterol-lowering effect, though that specific finding requires confirmation through further research.
Identifying Which Prostate Cancer Patients Benefit Most From Specialist Care
Because routine referral for every single prostate cancer patient may be unnecessary, an accompanying study published simultaneously in JACC CardioOncology sought to pinpoint high-yield subgroups.
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