Multicenter randomized trial of coronary plaque progression after leuprolide or relugolix ADT in men with prostate cancer

Androgen deprivation therapy (ADT) for men with prostate cancer (PCa) is associated with cardiovascular (CV) morbidity. The randomized REVELUTION trial, at 4 centers affiliated with Emory University (Atlanta, GA), compared coronary plaque progression with the GnRH agonist leuprolide (n=31) versus the GnRH antagonist relugolix (n=31) ADT for at least 6 months in men with nonmetastatic PCa without prior ADT who were receiving pelvic radiotherapy. Compared with relugolix, leuprolide was associated with a significantly greater 12-month increase in coronary artery total plaque volume (estimated difference +68.9 mm³; 95% CI 23.2-114.5) and coronary artery noncalcified plaque volume (+64.5 mm³; 31.6-97.3) after adjustment for baseline plaque volume, age, and statin use. There was no significant difference between the two groups in 12-month change in calcified plaque volume and low-attenuation plaque volume. The authors conclude that for men with PCa, leuprolide resulted in significantly greater coronary plaque progression compared with relugolix.