Hematologic Syndromes

The association of bleeding diathesis and intravascular coagulopathy abnormalities in patients with prostate cancer has been reported. Bleeding problems in the prostate cancer patient may result from the effects of the tumor on hemostatic mechanisms or from the treatment of the tumor by cytotoxic and other agents. Among the tumor-related bleeding problems are disseminated intravascular coagulation, primary fibrinolysis, thrombocytopenia, acquired platelet dysfunction, and circulating inhibitors or anticoagulants. Disseminated intravascular coagulation is associated with hypercoagulability state in most solid tumors, whereas in prostate cancer tumors the most common presentation is acute promyelocytic leukemia bleeding. Treatment-related bleeding disorders include the common problem of thrombocytopenia secondary to myelosup-pressive chemotherapy as well as the interesting micro-angiopathic hemolytic anemia syndrome associated with mitomycin C and other agents (de la Fouchardiere et al. 2003). The cornerstone of management of disseminated intravascular coagulation is treatment of the underlying condition. Unfortunately few effective therapeutic options are available in hormone refractory prostate cancer. The recent development of new active agents might reverse the situation. A case of acute disseminated intravascular coagulation (DIC) associated with hormone refractory prostate cancer was successfully treated with samarium 153 (Ruffion et al. 2000). However, systemic radiopharmaceutical treatment for bone metastases is theoretically contraindicated when disseminated intravascular coagulation occurs since the report of a death following strontium 89 therapy in 1994. Mitoxantrone chemotherapy has been reported to be effective in two patients with a survival of more than few months, but normalization of blood tests requires at least 1 week (Leong et al. 1994; Paszkowski et al. 1999).

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