Successful Management of Disseminated Intravascular Coagulation in Metastatic Castrate-Resistant Prostate Cancer With Lutetium-177: A Case Report and Review of the Literature

Disseminated intravascular coagulation (DIC) is a hematological disorder characterized by the abnormal activation of the coagulation system, which leads to widespread clotting and subsequent consumption coagulopathy. DIC is often associated with the progression of prostate cancer and can be a life-threatening condition. In this case report, we present a patient with recurrent DIC in the setting of advanced prostate cancer. His initial episode of DIC was effectively managed with a triple therapy regimen of leuprolide, docetaxel, and darolutamide. However, during a subsequent episode of DIC, which occurred with progression to widespread bone metastases, a single dose of Lu-177 vipivotide tetraxetan successfully resolved the condition. Circulating tumor DNA testing at the onset of the second episode of DIC revealed high levels of androgen receptor, CCND1, and PDGFRA gene amplification. This case not only underscores the critical importance of awareness, early diagnosis, and the prompt initiation of effective cancer therapy for managing life-threatening DIC associated with prostate cancer but also offers new molecular insights into the condition.