scholarly journals Leukoerythroblastosis in castration-resistant prostate cancer: A clue to diffuse bone marrow carcinomatosis

2019 ◽  
Vol 9 (2) ◽  
Author(s):  
Frank Sheng Fan ◽  
Chung-Fan Yang
Keyword(s):  
Prostate Cancer ◽  
Bone Marrow ◽  
Disseminated Intravascular Coagulation ◽  
Advanced Prostate Cancer ◽  
Bone Marrow Involvement ◽  
Specific Antigen ◽  
Previous History ◽  
Elevated Serum ◽  
Bone Marrow Examination ◽  
Intravascular Coagulation

A 66-year-old man with a previous history of advanced prostate cancer failing complete androgen blockade, docetaxel chemotherapy, denosumab, and abiraterone acetate as judged by persistent high serum levels of prostate specific antigen presented with exertional dyspnea, normocytic anemia, and thrombocytopenia. Leukoerythroblastosis was noted in his peripheral blood. Bone marrow examination disclosed diffuse bone marrow carcinomatosis from prostate cancer. Prolonged activated partial thromboplastin time, prothrombin time, and an extremely elevated serum level of D-dimer led to a diagnosis of disseminated intravascular coagulation. Magnetic resonance imaging of spine revealed extensive bone marrow involvement but bone scan showed only scanty bony metastasis. We like to call attention to the importance of prompt bone marrow examination once recognizing leukoerythroblastosis in patients with advanced prostate cancer. Survey of a possible coexistent disseminated intravascular coagulation is as well strongly recommended in this condition.

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

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Kavita Agrawal ◽  
Nirav Agrawal ◽  
Levin Miles
Keyword(s):  
Prostate Cancer ◽  
Weight Loss ◽  
Disseminated Intravascular Coagulation ◽  
Metastatic Prostate Cancer ◽  
Degradation Products ◽  
Specific Antigen ◽  
Mass Effect ◽  
Whole Body ◽  
Initial Manifestation ◽  
Intravascular Coagulation

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.

Predicting positive bone marrow biopsies (BMBs) in patients (PTS) with advanced prostate cancer (APC).

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 180-180
Author(s):  
David Lorente ◽  
Aurelius Gabriel Omlin ◽  
Carmel Jo Pezaro ◽  
Nina Tunariu ◽  
Roberta Ferraldeschi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bone Marrow ◽  
Multivariate Analysis ◽  
Advanced Prostate Cancer ◽  
Bone Scan ◽  
Iliac Crest ◽  
Univariate Analysis ◽  
Specific Antigen ◽  
P Value ◽  
Bone Marrow Biopsies

180 Background: Advanced prostate cancer (APC) is a molecularly heterogeneous disease, with evidence of clonal evolution that could be responsible for resistance to treatment. About 90% of patients (pts) with APC have bone metastases. The acquisition of a bone marrow biopsies (BMBs) is a safe and feasible technique for obtaining tissue, with a low rate of complications. We hypothesized that pre-biopsy clinical variables may increase the success rate of BMBs in APC. Methods: Standard BMBs of the iliac crest were performed in APC pts between October 2011 and June 2013. All pts signed ethics approved consent. In the control cohort (n=10) BMBs were collected in pts with normal CT and bone scan appearance. Minimum, maximum, and mean Hounsfield Units (HU) of the iliac crest on pre-biopsy CTs were determined. Clinical and laboratory variables were collected from the electronic record system. Biopsies were defined as containing 50 or more or 1 to 50 malignant cells or none (negative). Univariate analysis was performed to determine variables associated with biopsy positivity with 50 or more cells. For variables with p value<0.1, the optimal cut-off point was determined by ROC curve analysis. A multivariate analysis with optimal cut-off points was then performed. Results: A total of 71 BMBs were performed in 57 pts. None of the control biopsies in pts with normal CT and bone scan (10 of 10) contained tumor. A total of 46 of 61 BMBs (75.4%) were positive. 38 of 61 (62.3%) contained 50 or more cells. Prior treatments were docetaxel in 57 (79.2%) and abiraterone in 42 (58%) pts. Bisphosphonates had been used in 21 (28.8%) pts. The significant variables on univariate analysis were ALP more than or equal to 200 IU/L (p=0.059), prostate-specific antigen (PSA) more than or equal to 225 ng/mL (p=0.008), lactate dehydrogenase (LDH) more than or equal to 200 IU/L (p=0.09), mean HU more than or equal to 125 (p=0.000) and maximum HU more than or equal to 550 (p=0.001). These factors were tested in multivariate analysis. Only PSA and mean HU were significant in multivariate analysis. The combined PSA and mean HU score had an ROC AUC of 0.79. Conclusions: A combination of PSA and mean HU on CT could assist physicians in selecting APC patients/ iliac crest site more likely to have a positive BMB. Prospective evaluation is ongoing in a validation set.

scholarly journals Massive Bleeding as the First Clinical Manifestation of Metastatic Prostate Cancer due to Disseminated Intravascular Coagulation with Enhanced Fibrinolysis

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Mónica Palma Anselmo ◽  
Gustavo Nobre de Jesus ◽  
João Madeira Lopes ◽  
Rui M. M. Victorino ◽  
João Meneses Santos
Keyword(s):  
Prostate Cancer ◽  
Disseminated Intravascular Coagulation ◽  
Case Reports ◽  
Specific Antigen ◽  
Aminocaproic Acid ◽  
Massive Bleeding ◽  
Coagulation Disorder ◽  
Intravascular Coagulation ◽  
Multiple Bone Metastases ◽  
Epsilon Aminocaproic Acid

Disseminated intravascular coagulation (DIC) is the most frequent coagulation disorder associated with metastatic prostate adenocarcinoma. However, DIC with enhanced fibrinolysis as an initial presentation of prostate cancer is extremely rare. The appropriate treatment to control bleeding in these situations is challenging, controversial, and based on isolated case reports in the literature. A 66-year-old male presented at the emergency department with acute severe spontaneous ecchymoses localized to the limbs, laterocervical hematoma, and hemothorax. Prostate specific antigen level was 385 μg/L, bone scintigraphy revealed multiple bone metastases, and prostate biopsy confirmed adenocarcinoma (Gleason 9; 4 + 5). Laboratory investigation showed a pattern of enhanced fibrinolysis rather than the more common intravascular coagulation mechanism. Epsilon aminocaproic acid in monotherapy was initiated with a clear and rapid control of bleeding manifestations. This rare case of massive bleeding due to DIC with enhanced fibrinolysis as the first manifestation of prostate cancer suggests that in selected cases where the acute bleeding dyscrasia is clearly associated with a dominant fibrinolysis mechanism it is possible to use an approach of monotherapy with antifibrinolytics.

scholarly journals A CASE OF DISSEMINATED INTRAVASCULAR COAGULATION CAUSED BY ADVANCED PROSTATE CANCER

2020 ◽  
Vol 111 (3) ◽  
pp. 94-97
Author(s):  
Takeshi Fukazawa ◽  
Tadashi Tabei ◽  
Takuma Nirei ◽  
Risa Shinoki ◽  
Sogo Tsutsumi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Disseminated Intravascular Coagulation ◽  
Advanced Prostate Cancer ◽  
Intravascular Coagulation

N,N-diethyl-2-[4-(phenylmethyl)phenoxy]ethanamine in combination with cyclophosphamide: an active, low-toxicity regimen for metastatic hormonally unresponsive prostate cancer.

1995 ◽  
Vol 13 (6) ◽  
pp. 1398-1403 ◽  
Author(s):  
L J Brandes ◽  
S P Bracken ◽  
E W Ramsey
Keyword(s):  
Prostate Cancer ◽  
Bone Marrow ◽  
Hemorrhagic Cystitis ◽  
Specific Antigen ◽  
Elevated Serum ◽  
Serum Levels ◽  
Delayed Effects ◽  
Clinical Toxicity ◽  
Added Benefit ◽  
Low Toxicity

PURPOSE The intracellular histamine antagonist, N,N-diethyl-2-[4-(phenylmethyl)phenoxy]ethanamine. HCl (DPPE), potentiates chemotherapy cytotoxicity to malignant cells but protects normal tissue, including bone marrow, gut, and hair. We assessed the response to and clinical toxicity of DPPE/cyclophosphamide therapy in 20 patients with advanced hormonally unresponsive prostate cancer, 19 of whom were symptomatic. PATIENTS AND METHODS Subjects received a maximally tolerated dose of DPPE (6 mg/kg) intravenously (IV) over 80 minutes. Cyclophosphamide (600 to 800 mg/m2; maximum dose, 1,500 mg) was administered over the last 20 minutes of DPPE infusion. Treatments (usually outpatient) were given once weekly for 4 weeks, followed by a 1-week delay, and then 2 of every 3 weeks as long as the patient was deemed to benefit. RESULTS Five of seven patients (71%) with measurable soft tissue disease had a partial remission (PR). Three of 16 (19%) with assessable bone disease responded (one complete remission [CR] and two PRs). Nine of 18 (50%) with an elevated serum level of prostate-specific antigen (PSA) had more than a 50% (mean +/- SD, 78% +/- 14%) decrease. Eleven of 13 (85%) with bone pain had partial or complete resolution of this symptom; the PSA level and bone scan improved in six and two of these subjects, respectively. Acute treatment toxicity consisted of nausea/vomiting (six of 20) and ataxia (20 of 20), which correlated with peak serum levels of DPPE. Delayed effects (24 to 48 hours) consisted mainly of tiredness and mild nausea; one patient developed hemorrhagic cystitis. Bone marrow and hair follicle toxicity was negligible in 14 and 15 patients, respectively. CONCLUSION DPPE/cyclophosphamide appears to be an active regimen for metastatic prostate cancer, with the added benefit of relatively low toxicity.

A castrate-resistant metastatic prostate cancer patient with severe pancytopenia, successfully treated with docetaxel chemotherapy

2019 ◽  
Vol 26 (5) ◽  
pp. 1254-1258
Author(s):  
Anuradha Kunthur
Keyword(s):  
Prostate Cancer ◽  
Bone Marrow ◽  
Prostate Specific Antigen ◽  
Bone Marrow Involvement ◽  
Specific Antigen ◽  
Docetaxel Treatment ◽  
Castrate Resistant Prostate Cancer ◽  
Severe Pancytopenia ◽  
Castrate Resistant ◽  
Docetaxel Chemotherapy

Introduction Prognosis of metastatic castrate-resistant prostate cancer is poor with a median survival of 12 to 36 months. Bone metastasis is common, and bone marrow metastasis occurs later in the disease course. The median survival in these patients after bone marrow involvement is less than six months. We report a case of castrate-resistant prostate cancer patient presented with severe pancytopenia due to bone marrow involvement of prostate cancer, treated successfully with docetaxel chemotherapy. Post chemotherapy, the patient became transfusion independent and prostate-specific antigen improved to 0.1 ng/ml from 1051 ng/ml. Case report A 70-year-old gentleman with a history of metastatic prostate cancer on androgen deprivation therapy and polycythemia vera presented to emergency room with dizziness and melena. Workup revealed severe pancytopenia with platelet count of 12k and hemoglobin of 4.5 gm/dl. Bone marrow biopsy confirmed diffuse involvement of bone marrow with prostate cancer. Prostate-specific antigen was 1051 gm/dl. Management and outcome: The patient received 14 units of packed red blood cell, 10 units of platelet transfusion within one week. Docetaxel chemotherapy was started along with thrombopoietin agonist romiplostim and pegylated filgrastim. He received five cycles of docetaxel treatment. Post chemotherapy, the patient became transfusion independent and prostate-specific antigen improved to 1.17 ng/ml from 1051 ng/ml. The patient is still alive one year after the presentation with good quality of life and the prostate-specific antigen further improved to 0.1 ng/dl. Conclusion This case suggests that selected patients with severe pancytopenia, due to bone marrow infiltration of prostate cancer, can be treated with docetaxel chemotherapy and romiplostim support with significant response. Docetaxel treatment may be beneficial to unpack the marrow and for quicker response in patients with good performance status.

scholarly journals A case of metastatic prostate cancer and immune thrombocytopenia

2017 ◽  
Vol 24 (5) ◽  
pp. 434 ◽  
Author(s):  
D.M. Betsch ◽  
S. Gray ◽  
S.E. Zed
Keyword(s):  
Prostate Cancer ◽  
Bone Marrow ◽  
Advanced Prostate Cancer ◽  
Immune Thrombocytopenia ◽  
Metastatic Prostate Cancer ◽  
Bone Marrow Involvement ◽  
Bone Marrow Infiltration ◽  
Advanced Malignancy ◽  
New Diagnosis

Prostate cancer frequently metastasizes to bone, but bone marrow involvement is relatively less common. In advanced prostate cancer, significant bone marrow infiltration can result in hematologic abnormalities such as anemia and thrombocytopenia. We report the case of a patient who presented with a new diagnosis of thrombocytopenia at the same time that he presented with prostate cancer metastatic to bone. He was found to have immune thrombocytopenia (itp) which responded to treatment with steroids. We discuss this case and review the literature on itp in the setting of advanced malignancy.

scholarly journals Recurrent Colon Cancer: Presentation With Disseminated Intravascular Coagulation From Disseminated Carcinomatosis of the Bone Marrow

2021 ◽  
Vol 9 ◽  
pp. 232470962110122
Author(s):  
Sai Prasad Desikan ◽  
Nathan Mclaughlin ◽  
Charles McClain ◽  
Raman Desikan
Keyword(s):  
Bone Marrow ◽  
Colon Cancer ◽  
Disseminated Intravascular Coagulation ◽  
Bone Marrow Involvement ◽  
Rare Presentation ◽  
Intravascular Coagulation ◽  
Diffuse Intravascular Coagulation ◽  
Recurrent Colon Cancer ◽  
Hematological Changes

Diffuse carcinomatosis of the bone marrow (DCBM) is a rare clinical condition characterized by diffuse bone marrow involvement with hematological changes. This case study concerns a patient who presented with DCBM secondary to colon cancer with diffuse intravascular coagulation. This is a rare presentation of DCBM in colon cancer. The case study also elaborates on clinical features, pathogenesis, and therapy of this unique presentation.

Prostate Cancer

2018 ◽  
Author(s):  
Kathryn M. Wilson ◽  
Lorelei Mucci
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Family History ◽  
Prostate Specific Antigen ◽  
Advanced Prostate Cancer ◽  
Advanced Disease ◽  
African Ancestry ◽  
Specific Antigen ◽  
Dietary Factors ◽  
Increased Risk

Prostate cancer is among the most commonly diagnosed cancers among men, ranking second in cancer globally and first in Western countries. There are marked variations in incidence globally, and its incidence must be interpreted in the context of diagnostic intensity and screening. The uptake of prostate-specific antigen screening since the 1990s has led to dramatic increases in incidence in many countries, resulting in an increased proportion of indolent cancers that would never have come to light clinically in the absence of screening. Risk factors differ when studying prostate cancer overall versus advanced disease. Older age, African ancestry, and family history are established risk factors for prostate cancer. Obesity and smoking are not associated with risk overall, but are associated with increased risk of advanced prostate cancer. Several additional lifestyle factors, medications, and dietary factors are now emerging as risk factors for advanced disease.

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