The use of prophylaxis should be considered when screening for and treating prostate cancer in patients with hemophilia, according to a new study published in Haemophilia.
The study suggests that prophylaxis for at least 7 days with clotting factor concentrates (CFC) or desmopressin should be considered prior to prostate biopsies to minimize bleeding risk, and oral tranexamic acid (TA) should also be given 21 days postbiopsy.
Bleeding occurred in 11 out of 71 patients (12.8%) following prostate biopsies a median of 7 days after the procedure (range, 0-19 days). Of these bleeding episodes, 81.8% (n=9) were hematuria and 18.2% (n=2) were rectal bleeding.
“[Prostate cancer] is one of the most frequent cancers in the general population and also in PWH [people with hemophilia]. Hematuria, and hematospermia in > 50-year-old PWH should not be dismissed as caused by the underlying hemophilia and should quickly lead to a urology referral,” the authors said. Prostate cancer surgery should be considered a high risk of bleeding and management should be in line with other surgery types with high bleeding risk.
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Oral TA was recommended for 30 days postsurgery based on the study results. Prostate cancer was confirmed in 50 patients, of which 45 were localized, 4 diffused, and 1 metastatic. Active surveillance was proposed in 6 of the patients with treatment recommended for the other 44.
Twenty-eight out of the 44 patients (63.6%) received surgery while the other 16 received active treatment of hormonal therapy and/or radiation therapy. Bleeding occurred in 7 of the surgery patients (25%) and was major in 3 patients. Bleeding occurred in some patients following radiotherapy (n=3) and brachytherapy (n=1).
“The high risk of bleeding during radiotherapy underlines the need to consider prophylaxis with CFC or TA for at least 1 month after the radiotherapy sessions,” the authors said. “A multidisciplinary approach, including hematologists, is needed to guide PC screening and management in PWH, in order to choose the least invasive methods but with high sensitivity and specificity.”
A total of 1549 patients with hemophilia above 50 years of age were screened for prostate cancer at French hemophilia treatment centers during the study period of 2003 to 2018. Of these patients, 73 (4.6%) had suspected or confirmed prostate cancer and underwent treatment. The hemophilia was severe in 5 patients, moderate in 12, and mild in the remaining 56.
Gautier P, Guillet B, Sigaud M, et al. Prostate biopsy and prostate cancer management in patients with haemophilia: the experience of French Haemophilia Treatment Centres. Haemophilia. Published online February 24, 2022. doi:10.1111/hae.14507