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.
Subject(s)
Adenocarcinoma/secondary , Biopsy, Needle , Bone Neoplasms/secondary , Neoplasms, Hormone-Dependent/secondary , Neoplasms, Unknown Primary , Prostate-Specific Antigen/blood , Prostatic Neoplasms/diagnosis , Adenocarcinoma/blood , Adenocarcinoma/diagnosis , Adenocarcinoma/drug therapy , Adenocarcinoma/pathology , Androgen Antagonists/therapeutic use , Antineoplastic Agents, Hormonal/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Back Pain/etiology , Bone Neoplasms/blood , Bone Neoplasms/diagnosis , Bone Neoplasms/drug therapy , Bone Neoplasms/pathology , Diagnostic Imaging , Disseminated Intravascular Coagulation/etiology , Docetaxel , Drug Resistance, Neoplasm , False Negative Reactions , Fatal Outcome , Humans , Male , Middle Aged , Neoplasms, Hormone-Dependent/blood , Neoplasms, Hormone-Dependent/diagnosis , Neoplasms, Hormone-Dependent/pathology , Prostatic Neoplasms/blood , Prostatic Neoplasms/pathology , Prostatic Neoplasms/surgery , Taxoids/administration & dosage , Transurethral Resection of ProstateABSTRACT
Recently, recommendations for the use of the Oncotype DX assay in estrogen receptor-positive node-negative breast cancer patients were incorporated into guidelines from both the American Society of Clinical Oncology and the National Comprehensive Cancer Network. The Oncotype DX assay is a diagnostic test which measures changes in a set of 21 genes in order to predict the likelihood of disease recurrence and also to predict which patients are most likely to respond to chemotherapy. Oncotype DX has been available commercially since January 2004 and has been used for more than 85,000 patients. Drs. William J. Gradishar, Nora M. Hansen, and Barbara Susnik answered questions regarding the incorporation of the Oncotype DX breast cancer assay into routine clinical practice. This expert dialog offers an update and clinical insights into when, how, and why clinicians might incorporate the Oncotype DX assay into the management of their breast cancer patients. Also, the latest research into the benefit of the Oncotype DX assay in node-positive patients is discussed. Finally, sample case studies offer clinically relevant examples of the practical application of the Oncotype DX assay.