Symptomatic and Incidental Venous Thromboembolic Disease Are Both Associated with Mortality in Patients with Prostate Cancer

Abstract

IntroductionThe association between malignancy and venous thromboembolic disease (VTE) is well established. The independent impact of VTE, both symptomatic and incidental, on survival in patients with prostate cancer is not known. We conducted a retrospective cohort study to evaluate the effect of VTE of survival in prostate cancer.MethodsData regarding clinical characteristics, treatment and outcomes of 453 consecutive prostate cancer patients were collected. Fisher exact (categorical variables) and t-test (continuous variables) were utilized to test associations with VTE and mortality. Survival was estimated using the Kaplan Meier method. A Cox regression model was used to model the mortality hazard ratio (HR).ResultsAt diagnosis, 358 (83%) patients had early stage disease, 43 (10%) had locally advanced disease and 32 (7%) had metastatic disease. During the follow up period, 122 (27%) patients died and 41 (9%) developed VTE (33 deep vein thrombosis, 5 pulmonary embolism, and 3 patients with both DVT and PE). Twenty-five VTE events were symptomatic and 16 were incidentally diagnosed on CT scans obtained for other reasons. VTE was associated with increased mortality [HR 6.89 (4.29–11.08), p<0.001] in a multivariable analysis adjusted for cancer stage, performance status, treatments and co-morbidities. There was no difference in survival between patients who had symptomatic and incidental VTE.ConclusionVenous thromboembolic disease, both symptomatic and incidental, is a predictor of poor survival in patients with prostate cancer, especially those with advanced disease. Further studies are needed to evaluate the benefit of prophylactic and therapeutic anticoagulation in this population.

Effects of androgen-deprivation therapy on hypercoagulability in prostate cancer patients: A prospective, longitudinal study

“…28 Previous studies have documented a potential association between ADT and increased venous and arterial TE risk in PCa patients. 20,22,29 These studies, however, failed to explore the direct impact of ADT on coagulation and the independent role of disease burden.…”

Management of incidental pulmonary embolism

“…Several retrospective studies in patients with cancer indicate that incidental PE can have important effects on survival, as well as on recurrent VTE [50,[59][60][61][62][63][64][65]. In one study that included a control group of patients without PE, matched for age, cancer histology and severity, the median survival in patients with incidental PE was 8 months, compared to 12 months for the matched controls [50].…”

Venous thromboembolism in hematopoietic stem cell transplant recipients

“…Several studies have also reported an association of VTE, both symptomatic and incidental, with poorer survival in patients with cancer. 3,4,[77][78][79] This may be a less important consideration in HSCT recipients, especially those maintained in remission. In the absence of studies that justify withholding anticoagulation in patients with incidental VTE, the 2012 ACCP guidelines recommend treating incidental VTE in a manner identical to symptomatic VTE with fulldose anticoagulation for at least 3-6 months, and longer in the presence of persistent or recurrent cancer.…”