Primary Fibrinolysis as the Presenting Sign of Metastatic Prostate Cancer: One Case Report and Literature Review.

Primary fibrinolysis revealing a prostatic adenocarcinoma is rare. Most of the case are limited to biological abnormalities. Here, we describe an unusual case of hematuria and primary fibriolysis as the presenting manifestation of metastatic prostate cancer in a 52-year-old man. The patient consulted for hematuria, ecchymosis and bleeding gums for a month. B-type ultrasound examination showed normal image of prostate. Peripheral blood test showed that the counts of white blood cell, red blood cell and platelet were all in normal range. APTT, prothrombin time and thrombin time were normal. But fibrinogen levels continued to lower than 1.1g/l despite infusions of cryoprecipitate and fresh frozen plasma. Further tests suggested that D-dimer was 9.58 mg/l (normal range: <0.5mg/L), FDP 45 μg/ml, t-PA 90.30 ng/ml (1.00∼12.00 ng/ml), PAI-1 38.3 ng/ml (5.00∼45 ng/ml), α2-PI 118.00% (96.8∼118.8%), PLG 43.30% (57.8∼113.4%), prostate-specific antigen (PSA) 640.2 ng/ml (0∼4 ng/ml), Free PSA 64.2 ng/ml (0∼0.93 ng/ml). PET-CT revealed enhanced metabolizing rate of prostate with enlargement of lymph node in abdomen and multiple bone lesions including rib, vertebration and pelvis. Treatment with a luteinizing hormone-releasing hormone (LHRH) agonist (Diphereline) and a short course of an antiandrogen, led to normalization of all coagulation parameters within 2 weeks, and to clinical improvement and decline in the serum levels of PSA and fPSA. Three months later, the serum levels of PSA and fPSA were normal. We discuss the pathogenesis, differential diagnosis, and association of primary fibrinolysis with prostate cancer along with the management of this condition.