Randomized Study to Evaluate MACE in Patients With Prostate Cancer Treated With Relugolix or Leuprolide Acetate (REPLACE-CV)

Inclusion Criteria: Has voluntarily signed and dated the informed consent form prior to baseline visit; Is a male and 18 years of age or older on the day of signing and dating the informed consent form; Patient has sufficient cognitive function in the investigator's opinion to complete the questionnaires and other activities related to the study; Has a histologically or cytologically confirmed diagnosis of adenocarcinoma of the prostate; Is, in the opinion of the investigator, a candidate for at least 1 year of continuous ADT for the management of prostate cancer with one of the following clinical disease state presentations: Evidence of biochemical (prostate-specific antigen [PSA], confirmed with two measurements at least one week apart) or clinical relapse following local primary intervention with curative intent (such as surgery, radiation therapy, cryotherapy, or high-frequency ultrasound and not a candidate for salvage treatment by surgery); Newly diagnosed hormone-sensitive metastatic disease (metastases in regional lymph node[s] are considered N1 and will, therefore, be stratified as non-metastatic); Advanced localized disease unlikely to be cured by local primary intervention with curative intent; Patients receiving primary or salvage radiation therapy with adjuvant ADT; Patients with high-risk cardiovascular disease defined as prior history of MACE (myocardial infarction, stroke, coronary revascularization [including percutaneous procedures] or revascularization affecting cerebral blood flow [including carotid procedures]) > 1 month before enrollment in the study; OR Patients with ≥ 3 of the following cardiovascular risk factors: Age (≥ 55 years of age); Hypertension defined as self-reported high blood pressure, or use of a blood pressure-lowering medication; Diabetes defined as self-reported diabetes or use of hypoglycemic medication; Dyslipidemia defined as self-reported high cholesterol or use of a lipid-lowering medication; Current cigarette use, defined as smoking within the year prior to the screening visit; Family history of cardiovascular disease, defined as a myocardial infarction or stroke or coronary revascularization or revascularization affecting cerebral blood flow (ie, carotid procedures) or sudden death in a first-degree relative < 60 years old; Serum testosterone before starting relugolix or leuprolide acetate of ≥ 150 ng/dL (1.50 ng/mL or 5.2 nmol/L) within 6 months prior to screening; Serum PSA concentration of > 2.0 ng/mL (2.0 μg/L) or, when applicable, post radical prostatectomy of > 0.2 ng/mL (0.2 μg/L) within 6 months prior to screening (by medical history); Patients, in the opinion of the investigator, must be equally eligible for either treatment in the study. If either the patient or the physician has a strong preference that one of the treatments be prescribed over the other, the patient must not be enrolled; Patients must not be participating or intending to participate in an interventional therapeutic study. Exclusion Criteria: Any significant cardiovascular conditions per the investigator within 1 month before study entry including but not limited to: myocardial infarction, stroke, New York Heart Association class III or IV heart failure, thromboembolic events, major cardiovascular or cerebrovascular procedures or any other condition that in the investigator's opinion puts the patient at unacceptable risk to enter the study; Any major cardiovascular or cerebrovascular procedures planned within the 1 month after enrollment; Patients with QT interval corrected for heart rate (QTc) determined using Fridericia's formula (QTcF; QTcF = QT/[R-R interval {RR}^0.33]) > 470 msec within 6 months of screening; Uncontrolled hypertension (systolic blood pressure > 180 mm Hg or diastolic blood pressure > 110 mm Hg) at the time of screening; Previously received gonadotropin-releasing hormone (GnRH) receptor agonist (eg, leuprolide, goserelin, histrelin, triptorelin), GnRH receptor antagonist, or other forms of ADT (estrogen or antiandrogen) for > 18 months total duration. If ADT was received for ≤ 18 months total duration, then that therapy must have been completed at least 12 months prior to baseline. Once enrolled in the study, patients may be treated with ADT and anti-androgen (abiraterone, enzalutamide, apalutamide, darolutamide); Metastases to brain per prior clinical evaluation; Prescriber plans to switch from relugolix to leuprolide acetate or another GnRH agonist or antagonist or from leuprolide acetate to relugolix or another GnRH agonist or antagonist during the study; Treatment with any investigational product within 28 days or 5 half-lives (whichever is longer). Exception: treatment for prostate cancer with any investigational products where the mechanism of action is testosterone lowering. In this circumstance, there must be a minimum 12-month treatment free interval; Active malignancy beyond prostate cancer with the exception of the following: Adequately treated basal cell carcinoma or squamous cell carcinoma of the skin; Adequately treated Stage I cancer from which the patient is currently disease-free for ≥ 2 years; Any other cancer from which the patient has been disease-free for ≥ 5 years; Other malignancy upon agreement with the medical monitor.