Non-Metastatic Prostate Cancer with Severe Anemia: Case Report and Literature Review

Case Report

Ann Hematol Oncol. 2022; 9(5): 1407.

Non-Metastatic Prostate Cancer with Severe Anemia: Case Report and Literature Review

Li A, Ji Y, Shen K, Ma Z, Liu B, Su R, Zhang W, Wang Q* and Xue W*

Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China

*Corresponding author: Qi Wang & Xue W, Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

Received: August 24, 2022; Accepted: September 24, 2022; Published: October 01, 2022


Prostate cancer is one of the most common tumors of male urinary system and nearly causing any symptoms or signs in early stages. Complication as anemia has been rarely reported in non-metastatic prostate cancer. We present herein an extremely rare case of a local prostate cancer occurring in a 76-yearold man with a complication of severe anemia. As he was diagnosed of prostate cancer, he presented rising severe anemia with the hemoglobin level even down-regulated to 47 g/L. There has been no evidence of tumor metastasis to bone or bone marrow which mainly cause anemia in prostate cancer, supported by emission computed tomography and prostate specific membrane antigen positron emission tomography/computed tomography. According to his hematological tests, he was diagnosed with iron deficiency anemia. Despite the poor responsibility to erythropoietin and blood transfusion during the whole therapy period, his hemoglobin level gradually normalized 4 months after a robot-assisted radical prostatectomy with neoadjuvant endocrine therapy. To our knowledge, there was no such case of severe anemia accompanied with local prostate cancer ever described in the English literature. The case presentation is followed by a general discussion with an emphasis on the diagnosis and differential diagnosis. A review of literature regarding hepcidin and prostate cancer is also discussed.

Keywords: Non-metastatic prostate cancer; Anemia; Hepcidin; Case report and literature review


Prostate cancer is the second most common cancer in males [1]. The local tumor is characterized by the symptom of trouble urinating, decreased force in the stream of urinating, blood in semen and discomfort in the pelvic area. The metastatic pattern of advanced prostate cancer is bone pain as the bone tissue is the dominant metastatic site. Other sites of metastases include lymphatic nodes, liver, brain, retroperitoneum, kidney, adrenal gland and bone marrow [2]. Among them, bone marrow, accounts for extreme little metastases, can induce abnormal hemogram and anemia.

Hereby, we report an exceptionally rare case of non-metastatic prostate adenocarcinoma accompanied with severe anemia. This is considered the first case reported in the literature. Moreover, we further discuss the clinical, histological, immunohistochemical finding and provide a review of available literature.

Case Presentation

A 76-year-old man with a long history of mild anemia (hemoglobin level of 107 g/L) for ren years, with no necessary treatment, was found with the elevated PSA level as 5.85 ng/mL. As part of evaluation, his pelvic Magnetic Resonance Imaging scan (MRI) achieved the result of prostate cancer. Biopsy revealed poorly differentiated ductal adenocarcinoma with Gleason Score 3+4=7, and then his hemoglobin level was found decreasing to 50 g/L gradually (Figure 1). Bone marrow aspiration revealed overactivated nucleated cell proliferation, hyperplastic neutrophils, reduced erythroid ratio and increased platelet ratio. Moreover, his bone marrow iron staining showed that extracellular iron was moderate positive (++) and iron granulocytes accounting for 15%. Blood chemistry and flow cytometry disclosed no obvious abnormal results. He denied bone pain, chills, fever and other major systemic diseases. Since there was no clarified cause of anemia, with malignant hematological diseases excluded, he was diagnosed as cancer related iron deficiency anemia. He underwent symptomatic therapy as blood transfusion and erythropoietin agents, whereas his hemoglobin level was maintained at 60 g/L.