BMC research notes · 2014
A case of metastatic cancer with markedly elevated PSA level that was not detected by repeat prostate biopsy.
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Iwamura Hiromichi, Hatakeyama Shingo, Tanaka Yoshimi, Tanaka Toshikazu, Tokui Noriko, Yamamoto Hayato, Imai Atsushi, Yoneyama Takahiro, Hashimoto Yasuhiro, Koie Takuya, Yoshikawa Kazuaki, Ohyama Chikara
Аннотация
BACKGROUND: Prostate-specific antigen (PSA) is a widely used specific tumor marker for prostate cancer. We experienced a case of metastatic prostate cancer that was difficult to detect by repeat prostate biopsy despite a markedly elevated serum PSA level.
CASE PRESENTATION: A 64-year-old man was referred to our hospital with lumbar back pain and an elevated serum PSA level of 2036 ng/mL. Computed tomography, bone scintigraphy, and magnetic resonance imaging showed systemic lymph node and osteoblastic bone metastases. Digital rectal examination revealed a small, soft prostate without nodules. Ten-core transrectal prostate biopsy yielded negative results. Androgen deprivation therapy (ADT) was started because of the patient's severe symptoms. Twelve-core repeat transrectal prostate biopsy performed 2 months later, and transurethral resection biopsy performed 5 months later, both yielded negative results. The patient refused further cancer screening because ADT effectively relieved his symptoms. His PSA level initially decreased to 4.8 ng/mL, but he developed castration-resistant prostate cancer 7 months after starting ADT. He died 21 months after the initial prostate biopsy from disseminated intravascular coagulation.
CONCLUSION: CUP remains a considerable challenge in clinical oncology. Biopsies of metastatic lesions and multimodal approaches were helpful in this case.
CASE PRESENTATION: A 64-year-old man was referred to our hospital with lumbar back pain and an elevated serum PSA level of 2036 ng/mL. Computed tomography, bone scintigraphy, and magnetic resonance imaging showed systemic lymph node and osteoblastic bone metastases. Digital rectal examination revealed a small, soft prostate without nodules. Ten-core transrectal prostate biopsy yielded negative results. Androgen deprivation therapy (ADT) was started because of the patient's severe symptoms. Twelve-core repeat transrectal prostate biopsy performed 2 months later, and transurethral resection biopsy performed 5 months later, both yielded negative results. The patient refused further cancer screening because ADT effectively relieved his symptoms. His PSA level initially decreased to 4.8 ng/mL, but he developed castration-resistant prostate cancer 7 months after starting ADT. He died 21 months after the initial prostate biopsy from disseminated intravascular coagulation.
CONCLUSION: CUP remains a considerable challenge in clinical oncology. Biopsies of metastatic lesions and multimodal approaches were helpful in this case.
Предметные рубрики MeSH
AdenocarcinomaAndrogen AntagonistsAntineoplastic Agents, HormonalAntineoplastic Combined Chemotherapy ProtocolsBack PainBiopsy, NeedleBone NeoplasmsDiagnostic ImagingDisseminated Intravascular CoagulationDocetaxelDrug Resistance, NeoplasmFalse Negative ReactionsFatal OutcomeHumansMaleMiddle AgedNeoplasms, Hormone-DependentNeoplasms, Unknown PrimaryProstate-Specific AntigenProstatic NeoplasmsTaxoidsTransurethral Resection of Prostate