Systemic Coagulation Markers Especially Fibrinogen Are Closely Associated with the Aggressiveness of Prostate Cancer in Patients Who Underwent Transrectal Ultrasound-Guided Prostate Biopsy

Abstract

Objective: It has been well elucidated that multiple types of cancers are at high risk of thrombosis. Several studies have indicated the prognostic value of fibrinogen (Fib) and D-dimer (DD) in prostate cancer (PCa). However, it remains unclear regarding the association of the comprehensive coagulation markers with the clinicopathological features of PCa.

Methods: A total of 423 pathologically diagnosed patients with PCa were consecutively collected and stratified as low-intermediate-risk or high-risk groups. The association of coagulation parameters including Fib, DD, prothrombin (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and antithrombin III (AT-III) with clinicopathological features was determined by univariate and multivariate logistic regression analyses.

Results: The levels of Fib, DD, and PT were significantly higher in the high-risk group (p < 0.001, p < 0.001, and p = 0.043, resp.), while APTT, TT, and AT-III were similar between two groups (p > 0.05, all). Univariate logistic regression analysis demonstrated that Fib, DD, and PT were all positively correlated with high-risk PCa (OR = 2.041, p < 0.001; OR = 1.003, p < 0.001; OR = 1.247, p = 0.044). Nonetheless, after adjusting for PSA, grade, and stage, Fib (T3 vs. T1, OR = 15.202, 95% CI: 1.725-133.959, p = 0.014) but not DD or PT was the unique independent factor associated with high-risk PCa in the multivariate regression analysis.

Conclusions: Our study firstly revealed that Fib but other coagulation markers was independently associated with the severity of PCa, suggesting Fib might be useful in PCa risk stratification beyond PSA, stage, and grade.

Figure 1

PSA levels in different tertiles of fibrinogen, D-dimer, and PT in PCa patients. PSA = prostate-specific antigen; PT = prothrombin; PCa = prostate cancer.

Figure 2

The percentages of high-risk subjects in different tertiles of fibrinogen, D-dimer, and PT in PCa patients. PT = prothrombin; PCa = prostate cancer.