Purpose of reviewWith treatment advances, the most common cause of death in prostate cancer patients is cardiovascular disease. Discerning the contribution of prostate cancer treatment on cardiovascular complications versus the natural progression of cardiovascular disease remains an ongoing area of investigation. Evaluating the research and identifying opportunities for further investigation is critical for optimal care of this prostate cancer patient population.Recent findingsThe degree that hormone therapy contributes to cardiovascular morbidity and mortality remains uncertain with conflicting results from large meta-analyses. Underlying cardiovascular disease or multiple cardiovascular disease risk factors appear to compound the risk of adverse events. Drug-specific cardiotoxicity in prostate cancer treatment has not been fully delineated. Recent studies have suggested the potential for wide-ranging prostate cancer cardiotoxic effects, including atherosclerosis acceleration, myocardial infarction, cardiomyopathy, hypertension, arrhythmias, and stroke along with other thromboembolic diseases.SummaryThis review provides an overview of prostate cancer treatment, a comprehensive analysis of the literature linking androgen deprivation therapy and cardiovascular disease, a discussion of cardiovascular risk management and mitigation in prostate cancer patients, and an exploration of research opportunities within cardio-oncology for prostate cancer.