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

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

BMC Res Notes. 2014 Jan 29;7(1):64

Authors: Iwamura H, Hatakeyama S, Tanaka Y, Tanaka T, Tokui N, Yamamoto H, Imai A, Yoneyama T, Hashimoto Y, Koie T, Yoshikawa K, Ohyama C

Abstract
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.

PMID: 24476098 [PubMed – as supplied by publisher]

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