Disseminated Intravascular Coagulation as an InitialManifestation of Metastatic Prostate Cancer EmergentlyTreated with Docetaxel-Based Chemotherapy

A 70-year-old male presented with hematuria and bruising of arms and legs for the last three days. He also complained of urinaryfrequency 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 of60 mg/dl,fibrin degradation products (FDP) of more than 20μg/ml, and platelets of 88,000/μl. The impression was disseminatedintravascular coagulation (DIC). A search was initiated to determine the underlying etiology precipitating DIC. Due to urinarysymptoms and weight loss, prostate-specific antigen (PSA) was ordered. PSA was elevated at 942μg/dl. Computed tomography(CT) of the abdomen and pelvis without contrast showed an enlarged prostate with mass effect on the bladder base, left-sidedhydronephrosis, and numerous enlarged pelvic lymph nodes. A bone scan of the whole body showed increased sclerosis of theL3 vertebral body. There was a concern for metastatic prostate cancer precipitating DIC. Onfirst admission, our patient’s DICwas stabilized with FFP and cryoprecipitate transfusions. He refused chemotherapy, and degarelix was not economicallyfeasible. 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 confirmedmetastatic 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 withhematuria. Repeat PSA worsened to 1,970μg/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 docetaxelas an inpatient (after patient agreement). Within three days of starting chemotherapy, his hematuria resolved and DIC panelshowed consistent improvement.