Risk of thromboembolic diseases in men with prostate cancer: results from the population-based PCBaSe Sweden

Abstract

SummaryBackgroundCancer is associated with an increased risk of thromboembolic diseases, but data on the association between prostate cancer and thromboembolic diseases are scarce. We investigated the risk of thromboembolic disease in men with prostate cancer who were receiving endocrine treatment, curative treatment, or surveillance.MethodsWe analysed data from PCBaSe Sweden, a database based on the National Prostate Cancer Register, which covers over 96% of prostate cancer cases in Sweden. Standardised incidence ratios (SIR) of deep-venous thrombosis (DVT), pulmonary embolism, and arterial embolism were calculated by comparing observed and expected (using the total Swedish male population) occurrences of thromboembolic disease, taking into account age, calendar-time, number of thromboembolic diseases, and time since previous thromboembolic disease.FindingsBetween Jan 1, 1997, and Dec 31, 2007, 30 642 men received primary endocrine therapy, 26 432 curative treatment, and 19 526 surveillance. 1881 developed a thromboembolic disease. For men on endocrine therapy, risks for DVT (SIR 2·48, 95% CI 2·25–2·73) and pulmonary embolism (1·95, 1·81–2·15) were increased, although this was not the case for arterial embolism (1·00, 0·82–1·20). Similar patterns were seen for men who received curative treatment (DVT: 1·73, 1·47–2·01; pulmonary embolism: 2·03, 1·79–2·30; arterial embolism: 0·95, 0·69–1·27) and men who were on surveillance (DVT: 1·27, 1·08–1·47; pulmonary embolism: 1·57, 1·38–1·78; arterial embolism: 1·08, 0·87–1·33). Increased risks for thromboembolic disease were maintained when patients were stratified by age and tumour stage.InterpretationAll men with prostate cancer were at higher risk of thromboembolic diseases, with the highest risk for those on endocrine therapy. Our results indicate that prostate cancer itself, prostate cancer treatments, and selection mechanisms all contribute to increased risk of thromboembolic disease. Thromboembolic disease should be a concern when managing patients with prostate cancer.FundingSwedish Research Council, Stockholm Cancer Society, and Cancer Research UK.

Risk of thromboembolic disease in men with prostate cancer undergoing androgen deprivation therapy

“…Evidence from other studies suggests an increased risk of TED in men with PCa who undergo radical prostatectomy (RP) and pelvic lymph node dissection (PLND) [3,5]. We also found the risk of TED to be greater in all men with PCa and this risk was highest among men who underwent ADT, with a twofold increased risk of PE in these individuals vs the general Swedish male population [2]. This indicates that ADT alone may play a significant role in the increased risk of TED [2,3,5].…”

“…Previous analyses from the Prostate Cancer Database (PCBaSe) Sweden have shown that men on ADT are at the highest risk of TED among all men with PCa and that surgeries for PCa are associated with an increased risk of TED [1,2]. When comparing 45 065 men with PCa who underwent cancer surgery with an age-and residency-matched control population, we found a threefold increase in risk of pulmonary embolism (PE) after TURP [1].…”

“…Surgery and disease severity are known to increase the risk of thromboembolic disease (TED) in men with prostate cancer (PCa) [1][2][3][4][5][6][7][8][9]. The risk of TED is further enhanced in men with PCa treated with androgen deprivation therapy (ADT) [1,2,10,11]; however, it is unknown to what extent ADT influences the risk of TED when accounting for previous surgeries and disease progression.…”

“…The risk of TED is further enhanced in men with PCa treated with androgen deprivation therapy (ADT) [1,2,10,11]; however, it is unknown to what extent ADT influences the risk of TED when accounting for previous surgeries and disease progression.…”

A Rare Clinical Entity of Lung Cancer: Metastatic Peripheral Arterial Embolism

“…Infarction results when the tumor fragment is large enough to occlude the tissue's arterial perfusion. Most tumor emboli occur during surgery; a few occur in the early postoperative period (8)(9)(10)(11)(12). The delayed occurrence of these emboli may be due to tumor fragments that remain loosely adhered to the site of pulmonary vein ligation and then embolize after surgery with coughing or other movement, or perhaps emboli are temporarily detained in the left ventricular trabeculations or chordae tendineae (1,2).…”