Pharmacological prophylaxis of venous thromboembolism in contemporary radical retropubic prostatectomy: does concomitant pelvic lymphadenectomy matter?

The prevention of venous thromboembolism is a major concern in cancer patients undergoing pelvic surgery. Radical retropubic prostatectomy is a common treatment for localized prostate cancer and has been identified as a high risk procedure for postoperative venous thromboembolism. However, most patients diagnosed with prostate cancer in the current era have clinically localized, low volume disease and the risk of venous thromboembolism is very low. Multiple guidelines exist for the prevention of venous thromboembolism in patients undergoing radical retropubic prostatectomy and pharmacological venous thromboembolism prophylaxis is recommended. Most urological surgeons in the USA however, do not routinely utilize pharmacological prophylaxis. A major concern arises when radical retropubic prostatectomy is performed with a concomitant pelvic lymphadenectomy. Pharmacological prophylaxis is known to increase the rate of lymph drainage and the rate of lymphocele formation. Evidence suggests that lymphocele may be an independent risk factor for venous thromboembolism in the postoperative period. These factors raise concern over current guidelines calling for routine use of pharmacological venous thromboembolism prophylaxis in radical retropubic prostatectomy especially when lymphadenectomy is performed simultaneously.

North American white mitochondrial haplogroups in prostate and renal cancer.

PURPOSE: While the mitochondrion is known to be a key mediator of apoptosis, there has been little inquiry into the inheritance pattern of mitochondria in patients with cancer. We compared the mtDNA haplotype in patients with prostate and renal cancer to that in controls to determine if there is an association between mitochondrial genotype and cancer. MATERIALS AND METHODS: Haplotyping was performed using polymerase chain reaction/digest identification of key polymorphic sites in the mitochondrial genome. A total of 121 and 221 white men with renal and prostate cancer, respectively, were identified following pathological confirmation of cancer, while 246 white controls were selected randomly from a bank of cadaveric organ donor DNA. Statistical analysis was performed and ORs were calculated. RESULTS: Mitochondrial haplogroup U was a highly significant risk factor for prostate and renal cancer vs controls (16.74% and 20.66% vs 9.35%, Fisher's exact test p = 0.019 and 0.005, respectively). The association remained statistically significant in renal cancer even after Bonferroni adjustment for multiple comparisons. Haplogroup U carried an OR of 1.95 for prostate cancer and an OR of 2.52 for renal cancer. CONCLUSIONS: The inheritance of mitochondrial haplogroup U is associated with an approximately 2-fold increased risk of prostate cancer and 2.5-fold increased risk of renal cancer in white North American individuals. Therefore, individuals with this mitochondrial haplotype are in a high risk group. Because mitochondrial haplogroup U is found in 9.35% of the white United States population, there are more than 20 million individuals in this high risk group.