Low Platelet Count Not Necessarily a Reason to Postpone Surgery

July 2, 2010 Dear Mayo Clinic: Please let me know if it would be safe to undergo prostate cancer surgery with a low platelet count (111,000) and if there is anything that can be done to avoid complications of the surgery. Answer: Your platelet level is a bit lower than normal range, but not low enough to prevent prostate cancer surgery. Platelets, also called thrombocytes, are blood cell fragments that are crucial for blood clotting. So they are important to prevent excessive bleeding during surgery. The normal range is 150,000 to 450,000 platelets per microliter (µL) of circulating blood. The level can be determined with a simple blood test. Low platelet count, called thrombocytopenia, isn't a concern for most surgeries unless the level is less than 50,000 per µL. A platelet level of 111,000 per µL would be considered mild thrombocytopenia. It usually wouldn't require medical treatment and should not be a worry for surgery. Abnormal platelet function can be caused by taking commonly used drugs such as aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, and Plavix (clopidogrel). If you take these medications regularly, as a precaution your surgeon would likely request that you stop them prior to surgery. Please check with your doctor about the appropriate timing. If these types of drugs or non-platelet anti-clotting drugs such as Coumadin (warfarin) cannot be safely stopped temporarily, then perhaps alternatives to surgery should be considered. Other options would be active surveillance or radiation treatment, depending on the prostate cancer grade and stage and the overall health of the individual. If you have a lower platelet count or a history of excessive bleeding, your doctor would likely recommend a referral to a specialist such as a hematologist for further workup and an overall recommendation to help determine the best path to take. While your platelet count isn't a concern for surgery, there may be other risk factors to consider. Since 1966, Mayo Clinic has maintained a registry of men who have undergone prostate removal surgery. More than 20,000 men are in the registry, and we contact them regularly to check their health status. The registry has provided invaluable information regarding the short- and long-term complications of radical prostatectomy (surgery to remove a cancerous prostate gland and some surrounding tissue). Factors to consider:

• Overall health: Some prostate cancers can be considered low risk. Treatments such as surgery are considered when the patient is in generally good health and has a life expectancy of at least 10 years. When overall health isn't good, a longer recovery and possible complications make surgery a less viable option. Patients who are obese, have vascular disease, or uncontrolled diabetes have a higher risk of complications.
• Type of surgery: There are different surgical options for prostate removal. Each patient's situation can determine which type of surgery is best. Mayo Clinic's data and other research show that the outcomes and risk of complications are about the same for all surgical approaches.
• Surgeon's experience/surgery volume: Several studies have shown that no matter which type of prostate surgery is performed, patients do better with an experienced surgeon. Results also are better in health care centers that do a high volume of prostate removal operations.

Surgery is very effective for prostate cancer but is not the only treatment. In general, the risk of serious complications from surgery is quite low. As you consider your treatment options, talk with your doctor and/or surgeon about all of your choices and ways to increase the likelihood of a good outcome. — R. Jeffrey Karnes, M.D., Urology, Mayo Clinic, Rochester, Minn.

Related Articles