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• W2046114628 abstract "A 77-year-old man presented with significant lower urinary tract symptoms, complaining of urinary frequency and poor flow. He had a normal feeling prostate. A cystoscopy was unremarkable apart from a polyp in the prostatic urethra that was biopsied. Histology revealed adenocarcinoma of the prostate, Gleason combined grade 8 (4+4). Transrectal ultrasound and biopsy was performed confirming adenocarcinoma in three of six cores. A bone scan and a computed tomography (CT) scan revealed no evidence of metastatic disease. Several weeks post cystoscopy his prostate specific antigen (PSA) level was raised at 8.1μg/litre (normal <4.0 μg/litre); however, this settled 2 weeks later at 3.3 μg/litre. After discussion, he was commenced on hormone ablation therapy (cyproterone acetate, a steroidal antiandrogen) because of ongoing voiding symptoms and a further normal cystoscopy. A biochemical response to treatment was achieved with his PSA falling to 0.6 μg/litre. This remained low 6 months later, so the antiandrogen was ceased, with a view to recommencing if symptoms developed or if his PSA rose. He presented to his GP 6 months after cessation of therapy with shortness of breath. His PSA remained low at 0.2 μg/litre. A CT scan of his abdomen was normal but the chest X-ray (CXR) revealed multiple pulmonary nodules, with no pleural effusion or pulmonary oedema (Figure 1). A CXR performed at diagnosis of his prostate cancer was normal. The thoracic unit was consulted, with the possibility of a new primary neoplasm raised, given his normal PSA and the fact that he was an ex-smoker. Bronchoscopy was performed with negative cytology and biopsy. A wedge biopsy of the right lung was then undertaken reporting positive histology consistent with metastatic prostatic adenocarcinoma, comparable to previous biopsies (Figure 2). Immunohistochemistry for PSA (Figure 2) and prostatic acid phosphatase were both positive, confirming the metastasis to be of prostatic origin. Upon review 1 month after his biopsy, a rapid acceleration was noted with his PSA climbing to 22 μg/litre. Hormone ablation treatment was commenced and a subsequent radionuclide bone scan revealed metastatic prostate cancer to his pelvis." @default.
• W2046114628 created "2016-06-24" @default.
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• W2046114628 date "2004-02-01" @default.
• W2046114628 modified "2023-10-18" @default.
• W2046114628 title "Metastatic prostate cancer to lung with normal prostate specific antigen levels" @default.
• W2046114628 cites W10191693 @default.
• W2046114628 cites W2015256869 @default.
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• W2046114628 doi "https://doi.org/10.12968/hosp.2004.65.2.12072" @default.
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