Yes, prostate cancer significantly increases the risk of both deep vein thrombosis and pulmonary embolism.
Men with prostate cancer have approximately a 50% increased risk of venous thromboembolism (VTE) compared to men without prostate cancer, with this elevated risk persisting throughout the 5 years following diagnosis 1. This encompasses both deep vein thrombosis (DVT) and pulmonary embolism (PE), which together constitute VTE.
Magnitude of Risk
The evidence demonstrates a clear dose-response relationship:
- Overall VTE risk: Men with prostate cancer show adjusted hazard ratios of 1.48 for DVT and 1.47 for PE 1
- Time-dependent risk: The risk is highest early after diagnosis, with an incidence proportion ratio of 2.53 at 6 months, declining to 1.59 at 5 years 1
- Absolute rates: Crude incidence rates are 6.54 per 1000 person-years in prostate cancer patients versus 4.27 per 1000 person-years in matched controls 1
Treatment-Specific Considerations
The thrombotic risk varies substantially by treatment modality:
Androgen Deprivation Therapy (ADT)
ADT carries the highest thrombotic risk among prostate cancer treatments 2, 3. Men receiving primary endocrine therapy show:
- DVT risk: SIR 2.48 (95% CI 2.25-2.73)
- PE risk: SIR 1.95 (95% CI 1.81-2.15)
- Duration-dependent effect: Longer ADT exposure correlates with more thrombotic events 3
- Recent data confirms DVT incidence is significantly higher with radiation therapy plus ADT compared to radiation alone 4
Curative Treatment (Surgery/Radiation)
Patients receiving curative treatment show intermediate risk:
- DVT: SIR 1.73 (95% CI 1.47-2.01)
- PE: SIR 2.03 (95% CI 1.79-2.30) 2
Active Surveillance
Even men under surveillance without active treatment demonstrate elevated risk:
- DVT: SIR 1.27 (95% CI 1.08-1.47)
- PE: SIR 1.57 (95% CI 1.38-1.78) 2
This suggests that prostate cancer itself, independent of treatment, confers thrombotic risk.
High-Risk Patient Identification
Clinicians should be particularly vigilant for VTE in prostate cancer patients with:
- High comorbidity burden: The interaction between prostate cancer and high comorbidity levels accounts for 29% of the VTE rate in these patients, with a 1-year VTE rate of 15 per 1000 person-years 5
- Metastatic disease: Visceral metastases significantly increase VTE risk 6
- Elevated plasma tumor DNA: In metastatic castration-resistant disease, elevated ptDNA shows a 5.78-fold increased VTE risk (HR 5.78,95% CI 1.63-20.44) 6
- Age ≥75 years: Older age independently increases both TE and VTE risk 7
- Elevated inflammatory markers: C-reactive protein ≥0.35 mg/dL increases TE risk (SHR 2.91) 7
Clinical Implications
Perioperative Prophylaxis
Following ASCO 2023 guidelines 8:
- Standard prophylaxis: LMWH or unfractionated heparin starting 12 hours to 2 hours preoperatively, continued for 7-10 days postoperatively (strong recommendation, high-quality evidence)
- Extended prophylaxis: For major abdominal/pelvic cancer surgery, consider 4-week LMWH prophylaxis (strong recommendation) or alternatively rivaroxaban/apixaban after initial LMWH/UFH (weak recommendation, low-quality evidence) 8
VTE Treatment
If VTE develops, apixaban is now a preferred option alongside LMWH, with strong recommendation and high-quality evidence for reducing recurrent VTE with low major bleeding risk 8. Treatment should continue for at least 6 months 9.
Monitoring Strategy
Do not wait for symptoms to develop in high-risk patients. The median time to VTE is 2.5 years in prostate cancer patients 1, but risk is highest in the first 6 months. Physicians should maintain heightened clinical suspicion, particularly in patients receiving ADT, those with metastatic disease, or those with multiple comorbidities.
Important Caveat
Notably, arterial embolism risk is NOT increased in prostate cancer patients (SIR 1.00) 2, distinguishing the thrombotic profile from some other malignancies. The risk is specific to venous thromboembolism.