Intensive Cholesterol-Lowering and CD8+ T Cells in Prostate Cancer

Inclusion Criteria:

1. Provision of signed and dated informed consent form.

2. Stated willingness to comply with all study procedures and availability for theduration of the study.

3. At least one Atherosclerotic Cardiovascular Disease (ASCVD) risk factor, such as:

4. ≥ 50 years of age

5. Hypertension

6. Hypercholesterolemia

7. Diabetes

8. Current or former smoker

9. First-degree family history of any cardiovascular heart disease

10. BMI > 25

11. On hypertension treatment, statin, and/or aspirin therapy

12. Patients with clinically localized prostate cancer. That is Low or intermediate riskprostate cancer defined as:

13. Pre-operative PSA (Prostate Specific Antigen) ≤ 20.0 ng/ml

14. Clinical stage T1c or cT2

15. Gleason score 3+3 or 3+4 or 4+3

16. Patients on AS with plans for surveillance biopsy

17. No previous treatment for prostate cancer with radiotherapy, chemotherapy, orhormonal therapy

18. Ability to take oral medication and be willing to adhere to once daily, oral Vytorinor ezetimibe.

19. Agree to avoid consumption of grapefruit and grapefruit juice ≥ one quart per daythroughout study duration.

Exclusion Criteria:

1. Current use of medications contraindicated for use with a statin such as strongCYP3A4 inhibitors (e.g., itraconazole, ketoconazole, posaconazole, erythromycin,clarithromycin, telithromycin, HIV protease inhibitors, and nefazodone).

2. Current use of medications contraindicated for use with ezetimibe (i.e.,gemfibrozil, cyclosporine, or danazol).

3. History of allergic or severe reaction to a either study agent.

4. History of moderate or severe myalgia with statin use.

5. Acute liver failure or decompensated cirrhosis

6. Already on maximum VYTORIN dose (10/80)

7. Already on medication(s) known to interact with Vytorin or Ezetimibe that mayprevent protocol-based escalation of cholesterol-lowering therapy frompre-enrollment baseline.

8. Already on a PCSK9 inhibitor