Successful Use of Samarium 153 for Emergency Treatment of Disseminated Intravascular Coagulation Due to Metastatic Hormone Refractory Prostate Cancer

Ruffion, A.; Manel, Anne‐Marie; Valignat, C.; Lopez, J.-G.; Perrin-Fayolle, Olivier; Perrin, Paul B.

doi:10.1016/s0022-5347(05)67308-9

Cited by 22 publications

(8 citation statements)

References 2 publications

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“…A variety of cytotoxic therapies, including mitoxantrone/prednisone and docetaxel with cisplatin, have been tried with some success [23,24]. In 1 case report, the radioactive isotope samarium-153 successfully managed DIC XFL in a castration-resistant patient [25]. Another account, however, implicated the radioactive isotope strontium-89 in the hemorrhagic death of a patient with preexisting low-grade DIC XFL [26].…”

Section: Discussionmentioning

confidence: 99%

Disseminated Intravascular Coagulation with Excessive Fibrinolysis in Prostate Cancer: A Case Series and Review of the Literature

2011

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Objectives: To describe the clinical characteristics, diagnostic features, prognosis, and outcome of patients with prostate cancer and disseminated intravascular coagulation with excessive fibrinolysis (DIC XFL). Methods: We performed a retrospective analysis of prostate cancer patients seen at a single center from March 21, 2000, to July 31, 2006, with a fibrinogen level <150 mg/dl and two of the following criteria: platelets <150 × 10⁹/l, D-dimer >0.5 µg/ml, prothrombin time and activated partial thromboplastin time exceeding normal values, hemorrhage and/or thrombosis. Patients with comorbid conditions that cause coagulopathy were excluded. Results: Forty-two patients met the inclusion criteria. Most patients had high-grade prostate cancer (26% had Gleason 7 and 45% had Gleason 8–10). Three patients developed DIC XFL following surgery and 39 patients in the setting of metastatic disease; 93% were resistant to castration, and 50% had received prior taxanes. No deep-vein thromboses were documented. Management included blood transfusion, heparin, hormones, and chemotherapy. Median survival was 4 weeks. DIC XFL reversal was seen in 20% of metastatic patients, all of whom received new chemotherapy regimens. Median survival in this group was 26 weeks. Conclusions: DIC XFL is a rare complication of prostate cancer. Untreated, the risk of hemorrhage is high and the prognosis poor. Reversal of DIC XFL appears to correlate with response to new anticancer therapy.

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Section: Discussionmentioning

confidence: 99%

Disseminated Intravascular Coagulation with Excessive Fibrinolysis in Prostate Cancer: A Case Series and Review of the Literature

2011

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“…DIC is the most common coagulation complication observed in prostate cancer patients. The incidence of DIC in prostate cancer is reported to be between 13 and 30% [1]. However, the clinical signs of DIC are apparent in only 0.4-1.65% of patients with prostate cancer [1].…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of DIC in prostate cancer is reported to be between 13 and 30% [1]. However, the clinical signs of DIC are apparent in only 0.4-1.65% of patients with prostate cancer [1]. Other coagulopathies associated with prostate cancer include thrombotic thrombocytopenic purpura, thrombosis, Trousseau's syndrome, and acquired factor VIII inhibitor development.…”

Section: Discussionmentioning

confidence: 99%

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Disseminated Intravascular Coagulation as an Initial Manifestation of Metastatic Prostate Cancer Emergently Treated with Docetaxel-Based Chemotherapy

Agrawal

Levin

2019

Case Reports in Oncological Medicine

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A 70-year-old male presented with hematuria and bruising of arms and legs for the last three days. He also complained of urinary frequency and hesitancy and weight loss of 40 pounds over a span of four months. Initial blood tests showed prothrombin time (PT) of 25.1 seconds, international normalized ratio (INR) of 2.5, partial thromboplastin time (PTT) of 43.9 seconds, fibrinogen of 60 mg/dl, fibrin degradation products (FDP) of more than 20 μg/ml, and platelets of 88,000/μl. The impression was disseminated intravascular coagulation (DIC). A search was initiated to determine the underlying etiology precipitating DIC. Due to urinary symptoms and weight loss, prostate-specific antigen (PSA) was ordered. PSA was elevated at 942 μg/dl. Computed tomography (CT) of the abdomen and pelvis without contrast showed an enlarged prostate with mass effect on the bladder base, left-sided hydronephrosis, and numerous enlarged pelvic lymph nodes. A bone scan of the whole body showed increased sclerosis of the L3 vertebral body. There was a concern for metastatic prostate cancer precipitating DIC. On first admission, our patient’s DIC was stabilized with FFP and cryoprecipitate transfusions. He refused chemotherapy, and degarelix was not economically feasible. Accordingly, he was started on androgen deprivation therapy (ADT), bicalutamide, and leuprolide as an inpatient, pending the tissue biopsy. The patient refused a prostate biopsy. A bone marrow biopsy was performed which confirmed metastatic prostate adenocarcinoma. The patient was stable for discharge with a plan for outpatient chemotherapy. Subsequently, he was lost to follow-up with the oncology. Six months after the initial presentation, he was readmitted with hematuria. Repeat PSA worsened to 1,970 μg/dl. Blood work was consistent with acute DIC. He refused chemotherapy again. So, he was restarted on ADT. However, his hematuria and DIC panel were worsening. He was emergently started on docetaxel as an inpatient (after patient agreement). Within three days of starting chemotherapy, his hematuria resolved and DIC panel showed consistent improvement.

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“…DIC has been reported to resolve spontaneously following resolution of the underlying condition and/or eliminating further activation of the coagulation cascade. For patients with prostate cancer, this may involve the use of chemotherapeutic agents 5,24,25 or hormonal therapy. 26,27 General supportive measures, including the administration of blood products such as fresh frozen plasma, cryoprecipitate, and platelets to replace the depleted clotting factors, have been used in acute care settings.…”

Section: Discussionmentioning

confidence: 99%

Disseminated Intravascular Coagulation Unmasked by Mohs Micrographic Surgery

Guldbakke

Schanbacher

2006

Dermatol Surg

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Successful Use of Samarium 153 for Emergency Treatment of Disseminated Intravascular Coagulation Due to Metastatic Hormone Refractory Prostate Cancer

Cited by 22 publications

References 2 publications

Disseminated Intravascular Coagulation with Excessive Fibrinolysis in Prostate Cancer: A Case Series and Review of the Literature

Disseminated Intravascular Coagulation with Excessive Fibrinolysis in Prostate Cancer: A Case Series and Review of the Literature

Disseminated Intravascular Coagulation as an Initial Manifestation of Metastatic Prostate Cancer Emergently Treated with Docetaxel-Based Chemotherapy

Disseminated Intravascular Coagulation Unmasked by Mohs Micrographic Surgery

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