Author: The Focal Therapy Clinic
Length: 8 min read
Published: 14 May 2025
Medically Reviewed: By Dr Aqua Asif

At a Glance

Prostate cancer and heart disease share common risk factors — including age, smoking, high blood pressure, diabetes, and raised cholesterol — but prostate cancer does not typically cause a heart attack directly. The clearest treatment-related link involves androgen deprivation therapy (ADT), which can alter cholesterol, blood sugar, and body composition in some men and may increase cardiovascular risk over time. At The Focal Therapy Clinic, our consultants review each patient’s full health profile — including heart health — before recommending any treatment pathway.

Key takeaways

  • Shared risk factors: age, smoking, diabetes, obesity, and high blood pressure raise risk for both heart disease and prostate cancer; a diagnosis of one warrants attention to the other.
  • ADT and the heart: androgen deprivation therapy can affect cholesterol, blood sugar, and body composition. Men with existing heart disease need careful monitoring before and during ADT.
  • Radiation is generally low-risk for the heart: in prostate cancer treatment, the heart is rarely in the treatment field; direct cardiac exposure is substantially lower than in chest cancer radiotherapy.
  • Lifestyle changes matter: stopping smoking, regular exercise, weight management, and a healthy diet can reduce avoidable cardiovascular risk during and after prostate cancer treatment.
  • For localized disease: selected men with localized prostate cancer may be suitable for focal therapy, which avoids ADT in most cases; suitability depends on individual cancer characteristics.

Do Prostate Cancer and Heart Disease share risk factors?

Heart disease is more common as men get older. Prostate cancer is also more common with age. This overlap is one reason the two conditions are often seen together.

Several factors can increase the risk of heart and blood vessel disease. These include:

  • smoking
  • high blood pressure
  • raised cholesterol
  • diabetes
  • carrying excess weight
  • low physical activity
  • family history of heart disease

These factors do not mean you will definitely develop heart disease. They are useful warning signs. They give you and your doctor a chance to lower risk early.

A prostate cancer diagnosis can also disrupt normal routines. Sleep, mood, activity and eating habits may change. This can make heart health easier to neglect, just when it needs more attention.

For most men, prostate cancer itself is not the direct cause of a heart attack. A heart attack usually happens when blood flow to the heart muscle is blocked. This is most often linked to disease in the heart arteries.

The more important link is shared risk. A man with prostate cancer may already have high blood pressure, diabetes or raised cholesterol. These may have been present before the cancer diagnosis.

Treatment can also matter. ADT can change how the body handles fat and sugar. This may add to existing heart risk in some men.

If you have chest pain, chest tightness, pain spreading to the arm, neck or jaw, severe breathlessness, collapse, or symptoms that feel like a heart attack, seek urgent medical care. Do not wait for a routine appointment.

Does ADT affect the heart?

Androgen deprivation therapy lowers testosterone. Testosterone can help prostate cancer cells grow, so reducing it can slow the cancer down.

ADT may be used in different situations. It is often used for advanced prostate cancer. It is also commonly used with radiotherapy for some men with intermediate-risk, high-risk or locally advanced disease.

ADT is not usually the main treatment for low-risk localised prostate cancer. Its role depends on cancer grade, stage, PSA level, scan results and your general health.

Lower testosterone can affect the body in several ways. Some men notice:

  • weight gain, especially around the waist
  • loss of muscle strength
  • tiredness
  • changes in cholesterol
  • changes in blood sugar
  • higher risk of diabetes in some cases
  • possible worsening of existing heart risk

This does not mean every man on ADT will develop heart problems. Many men complete treatment without a major heart event. The risk depends on your starting health, your age, your treatment length and your other medicines.

Evidence on ADT and heart risk

Research has linked ADT with changes in metabolic health. This means changes in weight, cholesterol, blood sugar and body composition. These changes can affect heart and blood vessel risk over time.

Guidelines now place more emphasis on checking cardiovascular risk before and during ADT. This is especially important if you already have heart disease, diabetes, high blood pressure or several risk factors.

There has also been interest in whether different types of ADT have different heart risks. Older hormone injections called GnRH agonists have been linked with increased cardiovascular risk in some studies. GnRH antagonists may have a lower risk in some research, but the evidence is not fully settled. Your doctors will consider the whole picture. This includes cancer control, heart history, convenience, side effects, bone health and other medicines.

Does Prostate Radiation Therapy affect Heart health?

Many patients ask whether prostate treatment radiation can harm the heart. In prostate cancer, the heart is not usually in the treatment field, unlike some chest cancers. Direct heart exposure is therefore lower. This means risk is generally lower than with cancers treated near the chest.

Prostate radiotherapy does not usually carry the same cardiac risks seen with breast or lung radiotherapy. However, older men receiving treatment may already have cardiovascular disease or other risk factors. General heart health still needs attention during care.

Some men also receive hormone therapy alongside radiation. In these cases, ADT may be more relevant to heart risk than radiation itself. Modern planning techniques continue to improve safety, and patients should discuss their individual risk with the treating team.

Lifestyle factors that matter most

Healthy habits can reduce cardiovascular risk and support recovery during prostate cancer treatment, though cannot replace treatment. Small consistent changes are often more effective than extreme short-term efforts. Support from family can improve success. The aim is consistency.

Helpful steps include:

  • Stopping smoking
  • Managing weight
  • Regular walking or resistance exercise
  • Good sleep habits
  • Managing blood pressure
  • Keeping diabetes well-controlled
  • Limiting excess alcohol
  • Controlling stress

A heart-friendly diet is also important. Meals rich in vegetables, fibre, oily fish, beans, and whole grains can support cholesterol and glucose control. Processed foods and excess sugar are best reduced.

 

 

Exercise can also improve fatigue and mood. Even brisk walking most days can help blood pressure and stamina. NICE recommends supervised resistance and aerobic exercise for men starting or having ADT, where this is suitable. Men should seek medical advice before starting intense training programmes.

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    What Heart Health Checks are useful during Prostate Cancer Treatment?

    Routine checks can identify problems before symptoms become serious. They also help your team adjust treatment safely.

    Useful checks may include:

    • Blood pressure
    • Weight and waist size
    • Cholesterol and other fats
    • Blood sugar or HbA1c
    • Smoking status
    • Exercise tolerance
    • Heart symptoms
    • Bone health, especially with longer ADT

    Some men may also need an ECG (heart tracing). This is more likely if there is a history of heart rhythm problems, heart disease, or medicines that affect the heart rhythm.

    Cancer follow-up remains important. PSA helps doctors monitor prostate cancer activity. It does not diagnose heart disease — heart symptoms need separate assessment.

    When to seek specialist care

    Some men benefit from extra heart input before starting prostate cancer treatment. This is especially true before ADT if there is known heart disease.

    A specialist review may be useful if you have:

    • Previous heart attack
    • Angina
    • Heart failure
    • Stroke
    • Abnormal heart rhythm
    • Diabetes
    • Several heart risk factors
    • New chest pain or breathlessness
    • New ankle swelling
    • Palpitations or fainting

    A dedicated service may be available in some hospitals or centres, where heart and cancer specialists work together. If not, your GP, cardiologist, oncologist and urologist can still coordinate care.

    The right treatment suitability depends on both cancer factors and general health. Men should feel comfortable asking whether alternative options may better fit their medical profile. Second opinions can also be valuable.

    The Focal Therapy Clinic approach

    For men with localised prostate cancer, treatment choice needs careful thought. Cancer control matters. So do urinary function, sexual function, recovery time, general health and personal priorities.

    Whole-gland treatments, such as surgery or radiotherapy, remain important standard options for many men. They may be the best choice for higher-risk or more widespread disease within the prostate.

    For selected men, targeted treatment may also be considered. Focal therapy aims to treat the known cancer area rather than the whole prostate. It aims to reduce damage to surrounding tissue and aims to preserve urinary continence and erectile function.

    Careful patient selection is essential. At the Focal Therapy Clinic, cases are reviewed by an experienced MDT team. The aim is to give balanced advice based on your cancer, your health and your priorities. The clinic provides personalised care from assessment through follow-up. You can also explore whether your cancer may meet focal therapy suitability criteria.

    FAQs

    Q: Is there a link between prostate cancer and heart disease?
    A: Yes, but it is usually indirect. Prostate cancer and heart disease often affect men in the same age group. They also share risk factors such as smoking, excess weight, diabetes, high blood pressure and raised cholesterol. Some prostate cancer treatments, e.g. ADT, can also affect metabolic and heart health.
    Q: How does ADT affect cardiovascular risk?
    A: ADT can worsen cholesterol, blood sugar control, and body composition in some men. For some men, these changes may increase the risk of diabetes, heart disease or stroke. Regular monitoring helps detect and manage these risks early.
    Q: What lifestyle changes help prostate cancer patients?
    A: Stopping smoking, regular physical activity, weight control and a healthy diet are key. Good sleep, lower alcohol intake and stress management can also help. These changes do not replace treatment. They support general health and may reduce avoidable risk.
    Q: Is a heart check useful before starting ADT?
    A: Yes, for many men. This is especially important if you already have heart disease, diabetes, high blood pressure, raised cholesterol, or several risk factors. Checks may include blood pressure, cholesterol, blood sugar, weight and sometimes an ECG.
    Q: Does radiation therapy harm the heart?
    A: The heart is not usually near the treatment area in prostate radiotherapy. This means direct heart exposure is usually low. If radiotherapy is combined with ADT, the hormone therapy is often more relevant to heart risk than the radiation itself.
    Q: Does PSA show heart problems?
    A: PSA is a prostate marker and does not indicate heart disease. It helps monitor prostate cancer activity rather than cardiovascular health. Heart concerns need separate assessment and testing.

    References

    Prostate Cancer UK. (n.d.). Hormone therapy. Available at: https://prostatecanceruk.org/prostate-information-and-support/treatments/hormone-therapy

    Prostate Cancer UK. (n.d.). Side effects of hormone therapy. Available at: https://prostatecanceruk.org/prostate-information-and-support/living-with-prostate-cancer/how-hormone-therapy-affects-you

    Cancer Research UK. (n.d.). Sex hormones, heart disease and diabetes. Available at: https://www.cancerresearchuk.org/about-cancer/prostate-cancer/practical-emotional-support/hormone-symptoms/sex-hormones-heart-disease-diabetes

    Lopes, R. D., Higano, C. S., Slovin, S. F., et al. (2021). Cardiovascular safety of degarelix versus leuprolide in patients with prostate cancer: The primary results of the PRONOUNCE randomized trial. Circulation, 144(16), 1295–1307. Available at: https://doi.org/10.1161/CIRCULATIONAHA.121.056810

    European Association of Urology. (2026). EAU Guidelines on Prostate Cancer. Available at: https://uroweb.org/guidelines/prostate-cancer

    National Institute for Health and Care Excellence. (2021). Prostate cancer: diagnosis and management (NG131). Available at: https://www.nice.org.uk/guidance/ng131

    European Society of Cardiology. (2022). 2022 ESC Guidelines on cardio-oncology. Available at: https://www.escardio.org/guidelines/clinical-practice-guidelines/all-esc-practice-guidelines/cardio-oncology-guidelines/

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