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It is well established that cancer increases the risk of blood clots, although the underlying mechanisms are not fully understood. Little is known about the specific association between prostate cancer and thromboembolic disease. However, previous research has suggested an increased likelihood of developing cardiovascular disease after endocrine therapy, an increasingly common treatment in men with prostate cancer. (Courtesy: King’s College London)

KING’S COLLEGE LONDON (UK)—Men with prostate cancer—particularly those receiving hormone therapy—are at increased risk of developing blood clots, a condition known as thromboembolism.

A recent article published in the Lancet Oncology is the first to show in detail an association between prostate cancer and thromboembolic disease, and should lead to increased surveillance in men with prostate cancer.

“Our findings indicate that it is important to consider thromboembolic side-effects when treating patients with prostate cancer, especially those who require endocrine (hormone) treatment,” says Mieke Van Hemelrijck, from the Division of Cancer Studies at King’s College London.

It is well established that cancer increases the risk of thromboembolism, although the underlying mechanisms involved are not fully understood. Indeed, patients with cancer are about four times more likely to develop a thrombosis (blood clot) than healthy individuals.

Little is known about the specific association between prostate cancer and thromboembolic disease. However, previous research has suggested an increased likelihood of developing cardiovascular disease after endocrine therapy, an increasingly common treatment in men with prostate cancer.

To provide more evidence, Van Hemelrijck and international colleagues assessed the risk of thromboembolic disease in Swedish men with prostate cancer receiving different types of treatment compared with Swedish men in the general population. The investigators used data from PCBaSe Sweden, which is based on the National Prostate Cancer Register (NPCR) of Sweden.

The NPCR of Sweden was started in 1996 and records more than 96 percent of all newly diagnosed prostate cancers and provides complete follow-up for each patient. For their analyses, the researchers used data on age, serum concentrations of PSA, treatment information at time of diagnosis, tumor grade and stage, socioeconomic status, history of thromboembolic disease, and rate of death.

Overall, findings showed that men with prostate cancer were significantly more likely to develop thromboembolic disease than men without prostate cancer. All three treatment groups were at increased risk of deep vein thrombosis and pulmonary embolism, but not arterial embolism.

Additionally, men receiving endocrine therapy had the highest risk of developing blood clots. Patients undergoing endocrine therapy were two-and-a-half times more likely to have a deep vein thrombosis than the general population, and nearly twice as likely to experience a pulmonary embolism.

This risk was especially high for men under 65 years old and men with advanced disease. Subset analyses showed a smaller increased risk of venous thromboembolism in patients treated with anti-androgens compared with other types of endocrine treatment.

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