A 57 year old patient who had undergone radical prostatectomy 3 years ago for localized prostate cancer developed acute palpitations and on investigations was found to have an elevated D-Dimer level. However there was no obvious pulmonary embolus nor was there any evidence of any clots/thrombus in the pelvic veins or lower extremities. Thus, the elevated D-Dimer level did not correlate with his medical condition.
Routine investigations also revealed a marginally elevated PSA (2.27 ng/ml) which in a patient who has undergone radical prostatectomy is significant.
A repeat D-Dimer and PSA level two weeks later showed an increase in both levels making the consulting physician wonder whether there was any connection with D-Dimer elevation and prostate cancer.

Discussion

Subsequently we got 3 patients with elevated PSA and a confirmed prostate cancer in 2 of them tested for D-Dimer with the following results:
#1 (Mr. S.D.S.) - Radical prostatectomy done 24 hours prior for a localized Ca Prostate PSA : 15.6 ng/ml (normal = 0 - 2.8).

#2 (Mr.S.M.M.) - PSA raised and biopsy done to diagnose Ca prostate (final histology awaited)
PSA : 5.8 ng/ml (normal = 0 - 2.8)

#3 (Mr. S.N.) - Localised Ca prostate awaiting surgery

PSA : 11.9 ng/ml (normal = 1 - 4)

In all 3 patients the D-Dimer value reported was > 0.5 < 1.0 (normal 0.0-0.5 ug).

Although we have not used any negative controls, previous reports have indicated that D-Dimer is not raised unless there is a thrombo-embolic phenomena and fibrinolysis is occurring.

These findings raise the question of whether there is any association between a raised D-Dimer value and prostate cancer/elevated PSA.

A large study will have to be conducted to investigate the relevance of this finding. We are now going to conduct a prospective study to determine the value of D-Dimer in all our prostate cancer patients and those with raised PSA due to non-malignant causes.