Enhanced vascular inflammation in patients with advanced prostate cancer receiving hormone therapy

Abstract Purpose While blocking androgen production and action effectively slows prostate cancer (PCa) progression, it is associated with significant side effects, including an increased risk of cardiovascular disease. Inflammatory activity within atherosclerotic arteries can be assessed using [ 18 F]FDG-PET imaging. Recently, [ 18 F]FDG-PET has also gained relevance in PCa patients - alongside PSMA-targeted PET - for evaluating tumor aggressiveness. This study investigated the effect of hormone therapy on arterial inflammation in PCa patients using [ 18 F]FDG-PET. Methods Thirty-two PCa patients receiving hormone therapy were compared to 17 age-matched PCa patients who had not undergone hormonal treatment in the 12 months prior to imaging. All participants underwent [ 18 F]FDG-PET/CT scans. Regions of interest (ROIs) were placed across several arterial segments, as well as in the superior vena cava (SVC), spleen, and bone marrow. To account for background vascular activity, blood-pool activity in the SVC was used for correction, and target-to-background ratios (TBRs) were calculated for each arterial segment. A semi-quantitative calcified plaque (CP) score was also recorded. Results Patients receiving hormone therapy exhibited significantly higher TBR max values in the abdominal aorta, ascending aorta, thoracic descending aorta, and in the combined analysis of all arteries (mean TBR max : 1.6 vs. 1.4; all p < 0.05). Similarly, TBR mean values were significantly elevated in the abdominal and ascending aorta, as well as in the combined arterial analysis (all p < 0.05). No significant differences were observed between groups in age, BMI, total cholesterol, LDL, CRP, or CP scores (all p > 0.05). Conclusion Advanced PCa patients undergoing hormone therapy demonstrate increased arterial inflammation on [ 18 F]FDG-PET imaging compared to non-hormonally treated controls. These findings support a possible mechanistic link between hormone therapy and the elevated cardiovascular risk observed in this patient population.