DICを伴った未治療前立腺癌の1例

Abstract

An 87-year-old man was referred to our hospital with a high suspicion of prostate cancer, because of high prostate-specific antigen (PSA) levels (1, 500 ng/ml). The laboratory results showed a PSA level of 1, 411 ng/ml, platelet count of 7.5×104/μl, and fibrinogen level of 68 mg/dl. D-dimer and fibronogen degradation product (FDP) levels were >240 and >480 μg/m respectively. Based on the above results, the patient was diagnosed as having prostate cancer with disseminated intravascular coagulopathy (DIC score=8 points). The patient was immediately hospitalized and heparin was administered to treat the DIC. On the 5th day, a prostate biopsy was performed and treatment was started with combined androgen blockade (CAB) therapy. The pathology report confirmed the diagnosis of prostate cancer with a Gleason Score of 4+3. Multiple bone and lymph node metastases were found on magnetic resonance imaging, computed tomography and, bone scans. Based on the results, the prostate cancer was stage cT3 N1 M1b. The medication was changed from heparin to nafamostat mesylate on the 12th day, due to the presence of DIC with the malignancy. After successful treatment with CAB, denosumab, and thrombomodulin alpha, the DIC levels improved (DIC score=3 points), and the PSA levels decreased to 51.5 ng/ml on the 47th day. DIC has been known to occur during treatment for prostate cancer ; however, cases of DIC with prostate cancer without any treatment are rare.