fosfestrol and Thrombocytopenia

Prostate is one of the most common sites of multiple primary cancer (MPC). We herein present two cases of prostate cancer associated with acute myeloid leukemia (AML) presenting as thrombocytopenia during endocrine therapy. After a diagnosis of prostate cancer (stage D2) was made, our patients received endocrine treatment with fosfestrol followed by a luteinizing hormone-releasing hormone (LH-RH) analogue and bicaltamide. Thrombocytopenia appeared 8 months and 10 months after the initiation of endocrine therapy, respectively. Because suspensions of bicaltamide resulted in further deterioration of thrombocytopenia, bone marrow aspirations were done with hematological examination revealing features of the M2 subtype of AML. Review of MPC with prostate cancer in the literature suggested that the combination of prostate cancer and AML was rare.

Topics: Adenocarcinoma; Aged; Antineoplastic Agents, Hormonal; Diethylstilbestrol; Humans; Leukemia, Myeloid, Acute; Male; Neoplasms, Multiple Primary; Prostatic Neoplasms; Thrombocytopenia

Transient thrombocytopenia was noted to occur in ten of 13 patients with advanced carcinoma of the prostate undergoing intravenous diethylstilbestrol diphosphate therapy. This was not associated with abnormalities of the initial platelet count or other parameters of the hemogram. There was no evidence of disseminated intravascular coagulation in these patients. No serious bleeding episodes occurred secondary to the thrombocytopenia. Following diethylstilbestrol diphosphate infusion, platelet counts generally returned to pretreatment levels. While the mechanism of action of the thrombocytopenia is unclear, we hypothesize a transient bone marrow toxicity as the cause of this phenomenon.

Topics: Adenocarcinoma; Bone Marrow; Diethylstilbestrol; Humans; Male; Platelet Aggregation; Platelet Count; Prostatic Neoplasms; Thrombocytopenia