The use of anticoagulants improves biochemical control of localized prostate cancer treated with radiotherapy

Abstract

BACKGROUND: Substantial experimental evidence suggests that anticoagulants (ACs) may inhibit cancer growth and metastasis, although the limited data from clinical trials have been inconsistent. The potential antineoplastic effect of ACs was investigated in patients who received radiotherapy for localized prostate cancer. METHODS: The study cohort consisted of 662 patients with adenocarcinoma of the prostate who received radiotherapy (RT) with curative intent. Among those 622 men, 243 (37%) were receiving ACs (warfarin, clopidogrel, and/or aspirin). All patients received external-beam RT, permanent seed implantation, or a combination of both. Prostate-specific antigen (PSA) values were monitored for biochemical control of disease. RESULTS: At a median follow-up of 49 months, the biochemical control rate at 4-years was significantly better in patients who received ACs at 91% compared with 78% in patients who did not receive ACs (P ¼ .0002). The distant metastasis rate at 4 years also was reduced in the AC group compared with the non-AC group (1% vs 5%; P ¼ .0248). In subgroup analysis, the improvement in biochemical control was significant only for patients with high-risk disease. Along with Gleason score, T classification, and initial PSA, the use of AC therapy was associated independently with improved biochemical control in multivariate analysis. CONCLUSIONS: AC therapy was associated with an improvement in biochemical control in patients with prostate cancer who received RT with curative intent. The effect was most prominent in patients who had high-risk disease.

Aspirin improves outcome in high risk prostate cancer patients treated with radiation therapy

“…Along with previous studies examining the association of AC use with radiation therapy, 9,10 these data would support a larger prospective trial examining AC use in PC patients treated with definitive radiotherapy to clarify the associations observed in these retrospective analyses. Such data along with ongoing trials examining aspirin in the metastatic setting will clarify whether routine use of ACs should be considered in PC.…”

“…2 There is substantial pre-clinical and clinical evidence that anticoagulants (ACs) including aspirin, clopidogrel, warfarin, and enoxaparin have anti-neoplastic properties in several types of malignancies including PC. 8 A potential association between the use of ACs and improved biochemical control for PC patients treated with radiotherapy was first reported by Choe et al 9 In that study, the 4-y FFBF was 91.2% among AC users, compared with 78% in patient not taking any ACs. Within the high-risk group, the difference was more robust (82% vs. 58%, P = 0.0007).…”

Elevated serum soluble CD40 ligand in cancer patients may play an immunosuppressive role

“…Anticlotting agents, such as aspirin and clopidogrel bisulfate (Plavix), have been shown to significantly lower sCD40L production in patients with type II diabetes and stable coronary artery disease, conditions in which platelet activation is a factor in pathogenesis. 36,37 A retrospective analysis of 682 prostate cancer patients showed significant benefit with the combination of anticlotting agents and radiation therapy, 38 adding clinical support to the hypotheses and findings of this study.…”

The clinicopathological and prognostic role of thrombocytosis in patients with cancer: A meta-analysis

“…These results indicated that thrombocytosis may be important in cancer development and progression, as numerous complex molecular mechanisms underlie cancer cell-PLT interactions (32). The potential predictive value of the association between thrombocytosis and 5-year overall survival and TNM stage revealed by the present study may be advantageous for use in clinical decision-making during risk categorization in patients with cancer.…”