How do you approach ADT in patients with high-risk prostate cancer who have risk factors for VTE, such as Factor V Leiden?
Do you routinely use VTE prediction scores (eg Khorana score) to guide thromboprophylaxis use in solid cancers?
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My default recommendation for patients with localized, high-risk prostate cancer is to recommend the use of long-term ADT. This intervention seems to offer a relatively large, clinically significant OS benefit for patients in the modern era receiving dose-escalated ADT. This benefit has been observed both in meta-analyses (Kishan et al., PMID 35469702) as well as individual phase III trials (e.g., Zapatero et al., PMID 25702876).
However, intensifying treatment always comes with increased risks. One of these risks may be VTE, a condition that can be morbid, potentially requiring hospitalization, and in some cases may result in mortality. ADT also appears to increase the risk of VTE in observational studies (Hemelrijck et al., PMID 20395174; ...
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