Hormonal therapy has been the treatment axis of metastatic prostate cancer since 1940. Identifying rare forms of debut is important in order to initiate the best treatment as soon as possible. Intravascular disseminated coagulopathy (DIC) related to prostate cancer is mostly presented as chronic forms. Acute forms can also be the way of presentation, recognizing them is crucial due to its life threatening nature. Here, we present a case of debut of metastatic prostate cancer as an acute DIC. Reporting this case is important because of the unfrequently presentation and to consider combined chemohormonal therapy since the diagnosis.