Prostate biopsy and prostate cancer management in patients with haemophilia: The experience of French Haemophilia Treatment Centres

Abstract

Background: Data are limited on prostate cancer (PC) management in patients with haemophilia (PWH). Aim: To describe PC screening and diagnosis, treatment modalities and bleeding complications in a group of unselected PWH followed at French Haemophilia Treatment Centres (HTCs) Patients and methods: PC screening, management and bleeding complications were retrospectively investigated at 14 French HTCs between 2003 and 2018. Results: Among> 1549 > 50-year-old PWHs, 73 (4.7%) underwent PC screening (median age 71.1 years; 67/6 HA/HB, 17/56 severe-moderate/mild). At diagnosis, haematuria was infrequent. Prophylaxis was administered during 76/86 (88%) prostate biopsies (PB) (n = 67 clotting factor concentrates, CFC; n = 9 desmopressin; n = 17 associated with tranexamic acid, TA). Bleeding (11/86, 12.8%) occurred mainly post-prophylaxis (median delay: 7 days): haematuria (9/11, 81.8%), and rectal bleeding

Managing prostatic illness in persons with haemophilia

“…The paper by Gautier and colleagues from 14 French haemophilia centres describing in the current issue of Haemophilia their questionnaire‐based survey is timely 5 . It reports the management of 86 PWH undergoing prostate biopsies and that of cancer in 50 older individuals between 2003 and 2018 (age range 56–87), 28 of them treated with surgery and the remaining 22 with other modalities.…”

“…Regarding the management of cancer surgery, the median time interval between objective diagnosis and treatment was as long as 3 months, even though the majority of cancers were fortunately localized (90%). 5 This unduly long post-diagnosis interval is perhaps due to poor experience with a rare disease such as haemophilia by the urologists and thus some degree of hesitancy. As expected for such a major surgical procedure all patients, irrespective of the severity of haemophilia, were prophylactically treated with factor concentrates for a much longer period than biopsy (median of 16 days for severe/moderate haemophilia and 10 for mild hemophilia A).…”

“…Even though bleeding episodes were generally mild and only one needed transfusion, these observations indicate that prostate biopsy should be managed with longer periods of short‐term prophylaxis, because it is a closed procedure that makes it difficult to secure local hemostasis. The prostate and urinary tract are organs rich in fibrinolytic activity, 6 so that it is wise, as suggested and done in a few cases by the French authors, 5 to use an adjuvant such as tranexamic acid during the perioperative and postoperative periods. The authors reported no case treated with TURP for benign hyperplasia, but we predict that this moderately invasive procedure would require a longer period of replacement therapy than biopsy.…”

“…Regarding the management of cancer surgery, the median time interval between objective diagnosis and treatment was as long as 3 months, even though the majority of cancers were fortunately localized (90%) 5 . This unduly long post‐diagnosis interval is perhaps due to poor experience with a rare disease such as haemophilia by the urologists and thus some degree of hesitancy.…”

“…The paper by Gautier and colleagues from 14 French haemophilia centres describing in the current issue of Haemophilia their questionnaire-based survey is timely. 5 It reports the management of 86 PWH undergoing prostate biopsies and that of cancer in 50 older individuals between 2003 and 2018 (age range 56-87), 28 of them treated with surgery and the remaining 22 with other modalities. What are the main general messages that can be drawn from this report, cognizant of the limitations of a questionnaire survey, the relatively small number of cases, and the long 15-year period covered by the survey?…”