# STAMPEDE analysis of 6292 men: intensified prostate cancer therapy did not significantly raise MACE

- Published: 2026-11-13 06:36 UTC
- Section: Life & Health › Medicine
- Tags: STAMPEDE trial, prostate cancer hormone therapy, major adverse cardiovascular events, androgen receptor pathway inhibitors, abiraterone enzalutamide, docetaxel zoledronic acid, SCORE2 validation, cardiovascular risk prostate cancer
- URL: https://realtech.media/news/rt-fd5cba3e16223eeb03a9eb77_stampede_analysis_of/

**A post hoc STAMPEDE analysis found no statistically significant rise in major cardiovascular events when abiraterone, enzalutamide, docetaxel, zoledronic acid or radiotherapy were added to ADT.**

![STAMPEDE analysis of 6292 men: intensified prostate cancer therapy did not significantly raise MACE](https://realtech.media/media/2026/11/a2a722b59d3ee033.jpg)
*lomazoma.com*

A post hoc analysis of the STAMPEDE trial examined major adverse cardiovascular events (MACE) in men with high-risk localized or metastatic prostate cancer who started long-term hormone therapy. The results were published in European urology and cover 6292 men whose trial data were linked to health care records in England [1].

MACE are a leading cause of noncancer death in men with prostate cancer. Androgen receptor pathway inhibitors (ARPIs) improve oncologic outcomes, but they may add to cardiovascular risk. The analysis compared treatment intensification with abiraterone acetate plus prednisolone (AAP), AAP plus enzalutamide (ENZ), docetaxel (DOC), zoledronic acid (ZA) and prostate radiotherapy (RT) against standard-of-care androgen deprivation therapy (ADT) alone.

## Cardiovascular events with ARPIs and other regimens

MACE were identified from prespecified ICD-10 and OPCS codes. The 5-year cumulative MACE incidence with ARPI intensification was 9% in nonmetastatic (M0) disease and 7% in metastatic (M1) disease, comparable to ADT alone [1].

ARPI intensification was not associated with a statistically significant increase in MACE risk. For AAP, the subdistribution hazard ratio (SDHR) was 1.15 (95% CI 0.80-1.67) in M0 and 1.36 (95% CI 0.87-2.10) in M1. For AAP plus ENZ, it was 1.34 (95% CI 0.91-1.98) in M0 and 1.28 (95% CI 0.85-1.94) in M1 [1]. No statistically significant increase was observed with DOC, ZA or prostate RT either. A history of cardiovascular disease was the strongest predictor of MACE.

## SCORE2 risk model performance

The authors also tested the Systematic Coronary Risk Evaluation 2 (SCORE2), which estimates 10-year cardiovascular risk and had not been validated in men treated for prostate cancer. Of 5076 patients eligible for assessment, 4239 had complete baseline data [1].

Discrimination was modest: the 10-year area under the curve was 0.63 for M0 disease and 0.61 for M1 disease. SCORE2 underestimated absolute cardiovascular risk, and the authors say this supports developing prostate cancer-specific cardiovascular risk models [1].

The authors note a limitation: patients with severe cardiovascular comorbidity were underrepresented in the analyzed population [1].

## Sources

1. [European urology](https://doi.org/10.1016/j.eururo.2026.09.001)
2. [lomazoma.com](https://lomazoma.com/intensivierte-prostatakrebstherapie-erhoeht-das-kardiovaskulaere-risiko-nicht-news-deutsches-aerzteblatt)

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Source: RealTech, realtech.media — https://realtech.media/news/rt-fd5cba3e16223eeb03a9eb77_stampede_analysis_of/