JAMA Cardiol

GnRH agonist drives faster coronary plaque progression than antagonist in prostate cancer trial

February 24, 2026

In an open‑label randomized trial of 62 men with nonmetastatic prostate cancer receiving pelvic radiotherapy plus ≥6 months of androgen deprivation therapy (ADT), the gonadotropin-releasing hormone (GnRH) agonist leuprolide led to significantly greater 12‑month coronary plaque progression than the GnRH antagonist relugolix. Compared with relugolix, leuprolide was associated with increased total plaque volume by +68.9 mm³ (P=0.02) and noncalcified plaque by +64.5 mm³ (P=0.004), with no meaningful differences in calcified or low‑attenuation plaque changes.

Clinical takeaway: When selecting ADT for patients with prostate cancer—especially those with cardiovascular risk factors—consider the lower observed coronary plaque progression with relugolix compared with leuprolide, and incorporate cardiovascular risk assessment and monitoring into treatment planning.

Source:

Patel SA, et al. (2026, February 18). JAMA Cardiol. Coronary Plaque Progression After Androgen Deprivation Therapy in Men With Prostate Cancer: A Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/41706486/