Disseminated intravascular coagulation and PC-SPES: a case report and literature review.
BACKGROUND
PC-SPES is a herbal remedy gaining acceptance amongst prostate cancer patients and health care providers due to credible laboratory and clinical studies. However, PC-SPES has not been assessed in the standard rigorous approval process mandated for conventional agents.


OBJECTIVE
To present a case of a patient with prostate cancer who, while using PC-SPES, developed disseminated intravascular coagulation (DIC). A review of the literature was conducted to determine if there is a relationship between PC-SPES and hemorrhagic disorders.


METHODS
Searches were conducted in MEDLINE (1966-December 2000) and the Cochrane Collaboration's database.


RESULTS
There are 116 clinical and laboratory based studies of PC-SPES published to date. There are no randomized controlled trials. Clinical studies have demonstrated a significant reduction in prostate specific antigen (PSA) levels within 6 weeks. Improved quality-of-life, reduction in the volume of tumor deposits and reduction in analgesic use has been demonstrated in hormone refractory patients. Laboratory studies suggest that the beneficial effects of PC-SPES are unrelated to physiologic estrogens. However, PC-SPES has a side-effect profile similar to diethylstilbestrol. There is data demonstrating a <5% risk of thromboembolic events, but this is the first report of DIC.


CONCLUSIONS
The study of PC-SPES is in its infancy. This case may serve as a cautionary note to health care providers and patients regarding herbal remedies. Those using PC-SPES should have an increased level of surveillance for bleeding disorders.
Lock
M
M
Department of Radiation Oncology, University of Toronto, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada.
Loblaw
D A
DA
Choo
R
R
Imrie
K
K
D000368:Aged; D000972:Antineoplastic Agents, Phytogenic / Q000009:adverse effects* / Q000627:therapeutic use; D004211:Disseminated Intravascular Coagulation / Q000139:chemically induced*; D004365:Drugs, Chinese Herbal / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010936:Plant Extracts / Q000009:adverse effects* / Q000627:therapeutic use; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000188:drug therapy*
D000972:Antineoplastic Agents, Phytogenic; D004365:Drugs, Chinese Herbal; D010936:Plant Extracts; C114209:herbal preparation PC-SPES; D017430:Prostate-Specific Antigen