Castration-Resistant Prostate Cancer Presenting as Bulky Lymphadenopathy: A Case without Bone Metastasis

Area of Science:

• Oncology
• Urology

Background:

• Prostate cancer (PCa) commonly metastasizes to regional lymph nodes and bone.
• Bone metastases occur in over 80% of metastatic PCa patients.
• Non-regional lymph node (NRLN) metastasis indicates advanced disease.

Purpose of the Study:

• To report a rare case of prostate cancer with non-regional lymph node metastasis without skeletal involvement.
• To emphasize the diagnostic utility of PSMA-PET imaging in identifying atypical metastatic patterns.

Main Methods:

• A case report of a patient with persistently elevated PSA post-localized PCa treatment.
• Utilized Prostate-Specific Membrane Antigen Positron Emission Tomography (PSMA-PET) scan for diagnosis.
• Administered treatment with abiraterone plus docetaxel.

Main Results:

• PSMA-PET revealed bulky retroperitoneal lymphadenopathy (NRLN metastasis) without bone metastasis.
• Treatment reduced PSA levels from 21 ng/mL to 2.42 ng/mL.
• PSMA-PET confirmed significant shrinkage of lymphadenopathy post-treatment.

Conclusions:

• Castration-resistant PCa typically metastasizes to bone, but this case shows rare NRLN metastasis without bone involvement.
• PSMA-PET imaging and genetic testing aid in identifying unusual metastatic patterns.
• Early recognition and personalized treatment strategies are crucial for improved patient outcomes.