Korean J Urol.  2010 May;51(5):358-361.

Progression of Prostate Cancer Despite an Extremely Low Serum Level of Prostate-Specific Antigen

• Lee DK
• Park JH
• Kim JH
• Lee SJ
• Jo MK
• Gil MC
• Song KH
• Park JW

Abstract

A 61-year-old man who had been diagnosed with prostate cancer 9 years ago and had been treated with pelvic irradiation and intermittent androgen deprivation therapy visited the emergency room because of back pain and weakness in both legs. Spine magnetic resonance imaging showed a lumbar epidural mass and spine metastasis. The whole-body workup revealed multiple metastases to the lymph nodes, bone, liver, and lung. The serum prostate-specific antigen was 0.02 ng/ml. He underwent laminectomy, posterior fixation, and epidural mass excision, and metastatic adenocarcinoma from the prostate was diagnosed. The patient underwent 1 cycle of docetaxel-based chemotherapy. More chemotherapy could not be done because of his general weakness. The patient died one month later of multiple organ failure.

Keyword

Disease progression; Multiple organ failure; Neoplasm metastasis; Prostate-specific antigen; Prostatic neoplasms

MeSH Terms

Adenocarcinoma
Back Pain
Disease Progression
Emergencies
Humans
Laminectomy
Leg
Liver
Lung
Lymph Nodes
Magnetic Resonance Imaging
Middle Aged
Multiple Organ Failure
Neoplasm Metastasis
Prostate
Prostate-Specific Antigen
Prostatic Neoplasms
Spine
Prostate-Specific Antigen

Figure

• 

  FIG. 1 (A) Histology of prostate adenocarcinoma of Gleason's grade 8 (4+4) 9 years previously. Irregular sizes of glands and fusioned glands are shown (H&E, ×400). (B) Histology of epidural metastatic adenocarcinoma of Gleason's grade 10 (5+5). No glandular differentiation and focal necrosis are shown (H&E, ×400).

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  FIG. 2 Clinical course of the patient. The serum prostate-specific antigen (PSA) level declined after irradiation and androgen deprivation therapy (ADT). The highest PSA was 3.05 ng/ml. Since 2007, the serum PSA level was 0.02 ng/ml.

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  FIG. 3 Multiple metastatic prostate cancer in the patient. (A) Abdomen and pelvic computed tomography (CT) showing multiple hepatic metastases. (B) Chest CT showing a small nodule of pulmonary metastasis. (C) Positron emission tomography (PET) showing multiple hepatic and aortocaval, paraaortic, and both common iliac lymph node metastases. (D) Whole-body bone scan showing an active bony lesion in L4.

Reference

1. Shin JS, Choi HJ, Choi YS, Chai SE, Choi HY. Predictive factor for the early progression of androgen independent prostate cancer in intermittent androgen deprivation therapy. Korean J Urol. 2004. 45:858–864.

2. Leibovici D, Spiess PE, Agarwal PK, Tu SM, Pettaway CA, Hitzhusen K, et al. Prostate cancer progression in the presence of undetectable or low serum prostate-specific antigen level. Cancer. 2007. 109:198–204.

3. Yamamoto S, Ito T, Akiyama A, Aizawa T, Miki M, Tachibana M. M1 prostate cancer with a serum level of prostate-specific antigen less than 10 ng/mL. Int J Urol. 2001. 8:374–379.

4. Namiki M, Ueno S, Kitagawa Y, Konaka H, Mizokami A, Koh E, et al. Hormonal therapy. Int J Clin Oncol. 2007. 12:427–432.

5. Na KI, Yoon DK, Cho JH. The change of serum prostate specific antigen after hormonal therapy of metastatic prostatic cancer. Korean J Urol. 1996. 37:1234–1238.

6. Sella A, Konichezky M, Flex D, Sulkes A, Baniel J. Low PSA metastatic androgen-independent prostate cancer. Eur Urol. 2000. 38:250–254.

7. Nishio R, Furuya Y, Nagakawa O, Fuse H. Metastatic prostate cancer with normal level of serum prostate-specific antigen. Int Urol Nephrol. 2003. 35:189–192.

8. Magklara A, Scorilas A, Stephan C, Kristiansen GO, Hauptmann S, Jung K, et al. Decreased concentrations of prostate-specific antigen and human glandular kallikrein 2 in malignant versus non-malignant prostatic tissue. Urology. 2000. 56:527–532.

9. Oefelein MG, Smith N, Carter M, Dalton D, Schaeffer A. The incidence of prostate cancer progression with undetectable serum prostate specific antigen in a series of 394 radical prostatectomies. J Urol. 1995. 154:2128–2131.