Thromboembolic Events after Surgery for Localized Prostate Cancer: Incidence, Risk Factors, and Survival Outcomes

Background The incidence of thromboembolism (TE) is lower in prostate cancer than in other malignancies, but its sequelae are associated with increased mortality. This study investigated the incidence, risk factors, and survival impact of TE in Asian population with localized prostate cancer undergoing surgical management. Methods This was a single-center retrospective cohort study of 4,880 localized prostate cancer patients who underwent surgical resection between March 1, 2002, and December 31, 2019. TE, venous thromboembolism (VTE), survival outcome, and related clinical variables were analyzed. Results The 3-month TE cumulative incidence was 0.33% and the 3-month VTE incidence was 0.16%. The 2-year TE and VTE incidence were 0.81% and 0.29%, respectively. Older age (≥75) (Subdistribution Hazard Ratio (SHR) 2.16, P = 0.0155) and an elevated C-reactive protein levels (≥0.35 mg/dL) (SHR 2.91, P = 0.0001) were significant risk factors for an increased incidence of TE. Older age (SHR 3.67, P = 0.0113) and pathological venous invasion (SHR 5.13, P = 0.0195) were significant risk factors for an increased incidence of VTE. The occurrence of VTE, older age, a history of diabetes, and high Gleason scores (≥8) were independently associated with poor survival. Conclusions The incidence of TE was low in this East Asian cohort of surgically treated patients with localized prostate cancer, however, VTE was an independent predictor of worse overall survival. These findings suggest that pharmacological thromboprophylaxis should be reserved for patients identified as being at high-risk for TE, whereas mechanical measures appear sufficient for the general low-risk cohort.