Key result
Prompt hormonal therapy for prostate cancer-associated PTTM yields over 10-year recurrence-free survival.
Why the study?
Pulmonary tumor thrombotic microangiopathy is a rare, often fatal pulmonary complication of malignancy characterized by rapidly progressive pulmonary hypertension and ante-mortem diagnostic difficulty.
Does prompt hormonal therapy improve survival in a patient with suspected pulmonary tumor thrombotic microangiopathy associated with metastatic prostate cancer?
Case Report (n=1)
Does prompt hormonal therapy improve survival in a patient with suspected pulmonary tumor thrombotic microangiopathy associated with metastatic prostate cancer?
Prompt initiation of cancer-directed therapy based on clinical suspicion of pulmonary tumor thrombotic microangiopathy can result in exceptionally long-term survival.
Alerts clinicians to consider PTTM in unexplained pulmonary hypertension with metastatic prostate cancer; leaves open whether early therapy modifies its course.
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare and often fatal pulmonary complication of malignancy, characterized by rapidly progressive pulmonary hypertension and difficulty in ante-mortem diagnosis. We report a case of PTTM associated with previously untreated metastatic prostate cancer in a 62-year-old man with an initial serum prostate-specific antigen level of 3,835 ng/mL and clinical stage cT3N0M1. 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) performed during the diagnostic workup revealed findings suggestive of pulmonary hypertension and right heart strain before the onset of overt respiratory failure. Shortly after prostate biopsy, the patient developed acute hypoxemic respiratory failure. Based on the clinical suspicion of PTTM, hormonal therapy was initiated promptly before pathological confirmation, resulting in rapid improvement of respiratory status. A definitive diagnosis of PTTM was subsequently established by pulmonary artery aspiration cytology obtained via right heart catheterization. The patient has remained alive for more than 10 years without recurrence of PTTM. This appears to represent the longest survival reported for PTTM to date. This case highlights the importance of early clinical suspicion and prompt cancer-directed therapy in patients with suspected PTTM.
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Nishida et al. (2026) conducted a case report in Pulmonary tumor thrombotic microangiopathy (PTTM) associated with metastatic prostate cancer (n=1). Hormonal therapy was evaluated on Survival without recurrence of PTTM. Prompt hormonal therapy for prostate cancer-associated pulmonary tumor thrombotic microangiopathy resulted in rapid respiratory improvement and over 10-year survival without recurrence.
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