Do you decrease the duration of hormones in a man with high risk prostate cancer and cardiac risk factors?

I do consider a shorter course of ADT in the setting of a patient with significant cardiac disease, but usually only after speaking with the patient's cardiologist to first determine if there may be other mitigating risk factors that are more readily modifiable. If the patient is older than 75 or has low testosterone at baseline, I will also strongly consider a shorter course of ADT.

The increased risk of cardiovascular mortality after androgen ablation data is mixed. In a pooled analysis of randomized trials in unfavorable-risk prostate cancer published in JAMA, ADT use was not associated with an increased risk of cardiovascular death but was associated with a lower risk of PCSM and all-cause mortality. That being said, the data which shows increased mortality for patients with underlying cardiac risk factors has shown increased mortality even with short term androgen ablation and thus it is not clear if reducing androgen ablation duration would make an impact on cardiac mortality but certainly would reduce other side effects.

Agree with all of @Dr. First Last's points. In the end, you often have to gauge the right thing to do based on the patient in front of you as much as on the literature. The truth of the matter is that I am often far more concerned about impacting negatively on bone mineral density (BMD) than cardiac health. The bulk of the BMD loss caused by ADT happens in those first 6 months or so, making shorter term courses just as potentially morbid as the long-term ones. This particular concern, along with data suggesting that the optimal duration of HT (where cardiovascular mortality does not start to outweigh prostate cancer-specific mortality benefit) appears to be a function of patient age and the number of cardiac risk factors (history of MI being a key one; Lester-Coll et al. Cancer 2013), may argue for a shorter course of ADT in select high-risk patients.