Pancytopenia as the Initial Presentation of Metastatic Prostate Cancer

Prostate cancer (PC) is the most prevalent malignancy in men (after lung cancer). It commonly presents with lower urinary tract symptoms such as urgency, hesitancy, and poor stream besides some patients may present with bone pain. Anemia is the most common presentation of solid tumors with bone marrow involvement, however, pancytopenia as the presenting feature is rare. Here, we describe a 60-year-old man with significant comorbidities in the past who now presented with symptomatic anemia without any urinary symptoms. On evaluation, he was found to have pancytopenia with elevated alkaline phosphatase levels. Work up for pancytopenia revealed metastatic deposits from the adenocarcinoma in the bone marrow. Further, he was diagnosed as a case of PC on transrectal prostate biopsy and managed with denosumab and maximal androgen blockade.