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Stage IV Prostate Cancer Presenting With a Low Prostate-Specific Antigen Level: A Case Report.

Brandon Weissman¹, Joseph L Sarow², Sumi Singh³

¹Otolaryngology, Lake Erie College of Osteopathic Medicine, Buffalo, USA.

|April 11, 2025

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This case study shows advanced prostate cancer in a man with low PSA. Early detection of metastatic prostate cancer requires vigilance beyond PSA levels, especially with unexplained bone lesions.

Area of Science:

Oncology
Urology

Background:

Prostate cancer is a common male malignancy often monitored by prostate-specific antigen (PSA) levels.
Metastatic prostate cancer typically presents with elevated PSA, but some cases exhibit low or minimal PSA elevation.
This challenges traditional diagnostic approaches and necessitates alternative evaluation strategies.

Observation:

A 70-year-old male with hypertension and hypertriglyceridemia presented with a fall, revealing lytic spinal lesions.
Initial investigations, including biopsy, were non-diagnostic, with a PSA of 3.42 ng/mL.
The patient later developed weight loss, confusion, and seizures, leading to a second biopsy confirming prostate cancer.

Findings:

A second biopsy confirmed prostate cancer, and positron emission tomography revealed stage IV disease.

Keywords:

advanced metastatic prostate cancer prostate cancer (pc)prostate cancer awareness psa (prostate-specific antigen)stage iv prostate cancer

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This case illustrates diagnostic challenges in prostate cancer with low or minimally elevated PSA levels.

Biological variability and PSA-producing subclones can contribute to delayed diagnosis.

Implications:

Clinicians must maintain a high suspicion for prostate cancer in patients with unexplained skeletal lesions, irrespective of PSA.
Prompt histopathological assessment and advanced imaging are crucial for timely diagnosis and treatment.
Androgen deprivation therapy with abiraterone and prednisone was initiated for this patient.