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  • Title: Disseminated intravascular coagulation with excessive fibrinolysis in prostate cancer: a case series and review of the literature.
    Author: Hyman DM, Soff GA, Kampel LJ.
    Journal: Oncology; 2011; 81(2):119-25. PubMed ID: 21986538.
    Abstract:
    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 × 10(9)/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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