A case of metastatic cancer with markedly elevated PSA level that was not detected by repeat prostate biopsy

BMC Research Notes

Chikara Ohyama¹  Kazuaki Yoshikawa²  Takuya Koie¹  Yasuhiro Hashimoto¹  Takahiro Yoneyama¹  Atsushi Imai¹  Hayato Yamamoto¹  Noriko Tokui¹  Toshikazu Tanaka¹  Yoshimi Tanaka¹  Shingo Hatakeyama¹  Hiromichi Iwamura¹ 

[1] Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan;Department of Urology, Mutsu General Hospital, 035-0071 Mutsu, Japan

关键词: Elevated PSA level;    Negative prostate biopsy;    Metastatic prostate cancer;   

Others  :  1134666
DOI  :  10.1186/1756-0500-7-64

 received in 2013-07-29, accepted in 2014-01-27,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Iwamura et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Roobol MJ, Kranse R, Bangma CH, van Leenders AG, Blijenberg BG, van Schaik RH, Kirkels WJ, Otto SJ, van der Kwast TH, de Koning HJ, et al.: Screening for prostate cancer: results of the Rotterdam section of the European randomized study of screening for prostate cancer. Eur Urol 2013, 64(4):530-539. doi:10.1016/j.eururo.2013.05.030. Epub 2013 May 25.
• [2]Pavlidis N, Pentheroudakis G: Cancer of unknown primary site: 20 questions to be answered. Ann Oncol 2010, 21(Suppl 7):vii303-307.
• [3]Ettinger DS, Arnoletti JP, Gockerman JP, Handorf C, Havlin KA, Jacobs CD, Javle M, Kvols L, Lenzi R, Rashid A, et al.: Occult primary cancer clinical practice guidelines. J Natl Compr Canc Netw 2005, 3(2):214-233.
• [4]Pavlidis N, Fizazi K: Carcinoma of unknown primary (CUP). Crit Rev Oncol Hematol 2009, 69(3):271-278.
• [5]Pentheroudakis G, Golfinopoulos V, Pavlidis N: Switching benchmarks in cancer of unknown primary: from autopsy to microarray. Eur J Cancer 2007, 43(14):2026-2036.
• [6]Alberti C: Carcinoma of unknown primary (CUP); some considerations about pathogenesis and diagnostic strategy, particularly focusing on CUPS pertaining to the Urology. G Chir 2012, 33(1–2):41-46.
• [7]Kwee TC, Kwee RM: Combined FDG-PET/CT for the detection of unknown primary tumors: systematic review and meta-analysis. Eur Radiol 2009, 19(3):731-744.
• [8]Kwee TC, Basu S, Cheng G, Alavi A: FDG PET/CT in carcinoma of unknown primary. Eur J Nucl Med Mol Imaging 2010, 37(3):635-644.
• [9]Han A, Xue J, Hu M, Zheng J, Wang X: Clinical value of 18 F-FDG PET-CT in detecting primary tumor for patients with carcinoma of unknown primary. Cancer Epidemiol 2012, 36(5):470-475.
• [10]Lazaridis G, Pentheroudakis G, Fountzilas G, Pavlidis N: Liver metastases from cancer of unknown primary (CUPL): a retrospective analysis of presentation, management and prognosis in 49 patients and systematic review of the literature. Cancer Treat Rev 2008, 34(8):693-700.
• [11]Djavan B, Ravery V, Zlotta A, Dobronski P, Dobrovits M, Fakhari M, Seitz C, Susani M, Borkowski A, Boccon-Gibod L, et al.: Prospective evaluation of prostate cancer detected on biopsies 1, 2, 3 and 4: when should we stop? J Urol 2001, 166(5):1679-1683.
• [12]Roehl KA, Antenor JA, Catalona WJ: Serial biopsy results in prostate cancer screening study. J Urol 2002, 167(6):2435-2439.
• [13]Adams JR Jr: Adenocarcinoma in ectopic prostatic tissue. J Urol 1993, 150(4):1253-1254.
• [14]Yamada T, Sakata Y, Hasegawa Y, Ogura Y, Yoshimura Y, Murata M, Soga N, Onishi T, Suzuki R, Yamakawa K, et al.: A case of Ectopic prostate cancer. Hinyokika Kiyo 2000, 46(5):363-366.
• [15]Hanada M, Hosino T, Mimata H: A case of Cyst-forming ectopic prostate cancer. Nishinihon J Urol 2006, 68:107-109.
• [16]Gardner JM, Khurana H, Leach FS, Ayala AG, Zhai J, Ro JY: Adenocarcinoma in ectopic prostatic tissue at dome of bladder: a case report of a patient with urothelial carcinoma of the bladder and adenocarcinoma of the prostate. Arch Pathol Lab Med 2010, 134(9):1271-1275.
• [17]Ogushi T, Saiko Y, Matsushima H, Suzuki T, Ogawa M: Ectopic prostatictissue in the interureteral ridge of the bladder. Jpn J Urol Surg 2001, 14(10):1149-1151.
• [18]Sato D, Miyashita Y, Himura I: A suspected case of occult prostatic carcinoma in a patient presenting with gastrointestinal symptoms. J Med Soc Toho 1999, 46:163-168.
• [19]Nakata S, Nakano K, Takahashi H, Shimizu K, Higashi H, Ohki K: [A case of prostate cancer diagnosed pathologically by bone metastatic site biopsy]. Nippon Hinyokika Gakkai Zasshi 2005, 96(4):507-510.
• [20]Ueda Y, Higuchii Y, Hashimoto T, Mitsui Y, Maruyamai T, Kondou N, Nojima M, Yamamoto S, Shincho M, Hirota S, et al.: [Prostate cancer diagnosed through the biopsy of the bone metastatic lesion; a case report]. Hinyokika Kiyo 2007, 53(5):327-330.
• [21]Wakatabe Y, Ohkusa H, Tabata K, Sugita A, Sasamoto H, Ikeda K, Kimura M, Matsumoto K, Sato T, Iwamura M, et al.: Two cases of prostate cancer patients with a multifocal bone tumor it was difficult to diagnose in spite of elevated PSA. The journal of the Kanagawa Medical Association 2009, 36:202-203.
• [22]Makino T, Kurokawa K, Negishi I, Arai A, Ogawa A: A case of prostate cancer diagnosed by bone biopsy of metastasis lesion. Nippon Hinyokika Gakkai Zasshi 2009, 100:417.
• [23]Shin TKY, Obinata D, Takatama K, Yoshida T: A case of prostatic cancer which we can diagnosed by the ureteral metastatic carcinoma. Japan J Urol Surg 2011, 24:65-68.
• [24]Fukumoto R, Soda T, Uehara M, Hayashi T, Oka D, Fujimoto N, Koide K: [A case of prostate cancer diagnosed by lymphadenectomy]. Hinyokika Kiyo 2012, 58(10):557-560.
• [25]Pavlidis N, Pentheroudakis G: Cancer of unknown primary site. Lancet 2012, 379(9824):1428-1435.
• [26]Shildt RA, Kennedy PS, Chen TT, Athens JW, O’Bryan RM, Balcerzak SP: Management of patients with metastatic adenocarcinoma of unknown origin: a Southwest Oncology Group study. Cancer Treat Rep 1983, 67(1):77-79.
• [27]Nahas CS, Meniconi MT, Birolini D: Metastatic cutaneous adenocarcinoma of unknown primary site. Case report. Arq Gastroenterol 2004, 41(2):129-131.
• [28]Zarghami N, Grass L, Diamandis EP: Steroid hormone regulation of prostate-specific antigen gene expression in breast cancer. Br J Cancer 1997, 75(4):579-588.
• [29]Tazawa K, Kurihara Y, Kamoshida S, Tsukada K, Tsutsumi Y: Localization of prostate-specific antigen-like immunoreactivity in human salivary gland and salivary gland tumors. Pathol Int 1999, 49(6):500-505.