ALL prostate cancer patients are at increased risk for blood clots!

A new epidemiological study from Sweden has suggested that all prostate cancer patients may be at slightly increased risk for thromboembolism (blood clots) compared to men in the general population, but the risk is greatest for men receiving hormone therapies.

Van Hemelrijck et al., in an article published today in Lancet Oncology, used the PCBaSe Sweden database (a database that gathers information on more than 95 percent of all Swedish cases of prostate cancer) to investigate the risk of thromboembolic disease in men with prostate cancer who were receiving endocrine treatment, curative treatment, or some form of surveillance.

They calculated what are known as standardized incidence ratios (SIR) for deep-venous thrombosis (DVT), pulmonary embolism (blood clots in the lungs), and arterial embolism (blood clots in arteries) for patients in the PCBaSe Sweden database and compared these to the expected rates of the same conditions in the total Swedish male population.

The basic results of their analysis were as follows:

  • The study included all men treated for prostate cancer between January 1, 1997, and December 31, 2007.
    • 30,642 men received primary endocrine (hormonal) therapy.
    • 26,432 men received curative treatment.
    • 19,526 men received some form of surveillance.
  • 1,881 patients developed a thromboembolic disease.
  • For men on endocrine therapy, compared to men without prostate cancer
    • The risk for DVT (SIR = 2·48) and the risk for pulmonary embolism (SIR = 1·95) were significantly increased.
    • There was no increase in risk for arterial embolism (SIR =1·00).
  • For men who received curative treatment, again compared to men without prostate cancer
    • The risk for DVT (SIR = 1·73) and the risk for pulmonary embolism (SIR = 2·03) were significantly increased.
    • There was again no increase in risk for arterial embolism (SIR =  0·95).
  • For men on surveillance, again compared to men without prostate cancer
    • The risk for DVT (SIR = 1·27) and the risk for pulmonary embolism (SIR= 1·57) were both increased — but not as much as for the patients receiving treatment of some type.
    • Again there was no increase in risk for arterial embolism (SIR= 1·08).
  • The increases in risks for thromboembolic disease were still evident when patients were stratified by age and by tumor stage.

The authors conclude that increased risk for thromboembolic disease should be of concern in the management of all patients diagnosed with prostate cancer, with most specific concern being focused on men who are receiving some form of hormonal therapy.

The “New” Prostate Cancer InfoLink is tempted to wonder whether such risk for thromboembolic disease correlates in any way with the reduction in prostate cancer-specific mortality that is associated with the long-term use of statins and non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs are most certainly associated with a reduction in risk for thromboembolic events, and since statins lower total and low-density cholesterol levels, they may also impact risk for thromboembolisms too.

Additional information about this story was provided by the Associated Press (see, for example, the story on the Forbes web site).

One Response

  1. Hello Sitemaster,

    This study comes as no surprise, but it is good to have a large-scale confirmation done in the disciplined Scandanavian health care environment.

    I too am thinking that statins and NSAIDS should make a difference. Several of the experts in androgen deprivation therapy for prostate cancer, whom I follow, are enthusiastic about statins.

    Tomorrow, 4/16, will be my first day “off-therapy” under my third cycle of intermittent triple hormonal blockade for a challenging case (bPSA 113.6, GS 4 + 3 = 7 — Epstein, stage 3, perineural invasion, all cores positive, most 100% cancer, Dx December 1999, but scans surprisingly essentially negative including ProstaScint at Johns Hopkins). I am highly pleased and grateful for how well I have done (twice hit PSA <0.01 before going off the Lupron and Casodex while continuing the Proscar, and now having stabilized at a nadir around 0.04 for several months — maybe a little AIPC), but one of my few regrets is not starting a statin drug earlier.

    But at least I did start simvastatin 3 years ago, so I've now passed that 3-year cut point which seems important in conveying greater benefit. I've been on Dr. Charles "Snuffy" Myers version of the prostate cancer diet/exercise/stress reduction regimen, and that and the drug have lowered my pre-statin cholesterol from around 250 (but great ratio) to, last July 6 (fasting): total cholesterol 198, HDL 87 (my doctor said "Wow!), calculated LDL 101, ratio 2.3, trigs 49 — really good numbers. I was really proud of that HDL of 87 until I talked to a buddy of mine, also on triple blockade and the Myers type diet, with an HDL of 95! That July result was after about 10 months of triple blockade during the first part of the third on-cycle that I am now just completing. I'll get new numbers in a few months, but I suspect they will also be excellent. I also have, at present, a low but normal blood pressure and low pulse — good cardio indicators.

    My story is one like similar stories of men who have done very well with the side effects of androgen deprivation by being diligent about using countermeasures for the actual and potential side effects.

    Thanks for calling attention to the Swedish study.

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