De novo Hormone-Sensitive Metastatic Prostate Cancer: A Rare Clinical Presentation, a Case Report
DOI: 10.22591/magyurol.2024.4.anikma.198
Authors:
Anik Mercédesz Amelita dr.1, Mangel László dr.2,
Szántó Árpád dr.1, Damásdi Miklós dr.1
1Pécsi Tudományegyetem, Klinikai Központ, Urológiai Klinika, Pécs (igazgató: Szántó Árpád)
2Pécsi Tudományegyetem, Klinikai Központ Onkoterápiás Intézet, Pécs (igazgató: Mangel László)
Summary
Introduction: In the therapy of prostate tumours, active surveillance may sseems to be a risky form of treatment to the patients as well as their attending doctors. The European Association of Urology (EAU) protocol states that the process should be follow of regular PSA and rectal digital examination, which sometimes needs to be supplemented with histological sampling, not forgetting the imaging assistance provided by prostate MR. Due to the coronavirus pandemic in recent years, the care of patients on active surveillance has become difficult, so a rare appearance of a co-morbidity could make the previously considered certain urological therapeutic choice completely uncertain.
Case report: Our 51-year-old asymptomatic patient was investigated during a control examination due to an elevated PSA value. A prostate biopsy gave the diagnosis of a low-risk prostate tumour, so we decided to start active surveillance, but due to the coronavirus pandemic, he was not monitored as often as he should have been. Next time, he appeared with locomotor pain, weight loss, night sweats and also felt enlarged tumours in the neck and armpit areas. Imaging tests confirmed tumour-suspicious lymph nodes. Sampling from axillary and abdominal lymph nodes showed the appearance of Non-Hodgkin lymphoma. A pelvic MR examination was performed, which evaluated space occupation with extraprostatic spread (PIRADS 5) in the right lobe of the prostate. Repeated prostate biopsy samples taken from the right lobe were described as infiltrative B-cell lymphoma and samples from the left lobe confirmed the prostate tumour known after our first sampling. The patient’s haematological treatment was started, and his complaints disappeared. Control pelvic MRI did not suggest the presence of a clinically significant tumour in the prostate (PIRADS 2).
Conclusion: The exact indication and implementation of active surveillance is vital in the case of low-risk prostate tumours. Progression on active surveillance may refer to the faults of risk assessment, or an appearance of a seconder disease. In these cases rebiopsy can clear the possible process and define the right therapeutic option. In our case, the chosen active surveillance proved to be a right decision which also offers the best quality of life to our patient.