Lowe F C, Somers W J
J Urol. 1987 May;137(5):1000-2. doi: 10.1016/s0022-5347(17)44330-8.
The disseminated intravascular coagulation syndrome is an untoward side effect of metastatic adenocarcinoma of the prostate. In addition to appropriate replacement of blood, platelets and clotting factors, prompt treatment of the prostatic carcinoma is required to correct the underlying pathophysiological defect. Ketoconazole is the ideal method for hormonal manipulation for patients with life-threatening complications of prostatic carcinoma (disseminated intravascular coagulation and acute paraparesis/paraplegia) because of its prompt onset of action in decreasing circulating concentrations of androgens to castrate levels. Serum testosterone levels are castrate within 48 hours of the initiation of therapy with ketoconazole as opposed to a minimum of 10 to 14 days with estrogens. A patient with spontaneous bleeding from disseminated intravascular coagulation was treated with 400 mg. ketoconazole every 8 hours and bleeding stopped within 48 hours. Ketoconazole is particularly valuable when a prompt therapeutic response is needed and orchiectomy is contraindicated because of bleeding diathesis (as in disseminated intravascular coagulation), delay in histological confirmation (as in acute paraparesis/paraplegia) or patient reluctance to undergo castration.
弥散性血管内凝血综合征是前列腺转移性腺癌的一种不良副作用。除了适当补充血液、血小板和凝血因子外，还需要及时治疗前列腺癌以纠正潜在的病理生理缺陷。酮康唑是对患有前列腺癌危及生命并发症（弥散性血管内凝血和急性轻瘫/截瘫）的患者进行激素调控的理想方法，因为它能迅速起效，将循环中的雄激素浓度降至去势水平。与使用雌激素至少需要10至14天相比，使用酮康唑治疗后48小时内血清睾酮水平即可降至去势水平。一名因弥散性血管内凝血而自发出血的患者，每8小时服用400毫克酮康唑，48小时内出血停止。当需要迅速产生治疗反应且由于出血素质（如在弥散性血管内凝血中）、组织学确诊延迟（如在急性轻瘫/截瘫中）或患者不愿接受去势手术而禁忌睾丸切除术时，酮康唑特别有价值。
