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A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
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Rapidly Progressing Prostate Cancer With Low Prostate-Specific Antigen and Gleason Score 5+5: A Case Report
Kosuke Uchida1, Akira Fujisaki1, Shin Imai1
1Department of Urology, Seirei Hamamatsu General Hospital, Hamamatsu, JPN.
Cureus
|April 21, 2025
Summary
This case highlights a rare, aggressive prostate cancer with a low PSA level. Standard treatments like androgen deprivation and radiotherapy proved insufficient, indicating a need for novel therapeutic approaches.
Area of Science:
- Oncology
- Urology
- Medical Oncology
Background:
- Advanced prostate cancer (T4N1M0) in an elderly male presented with severe urinary dysfunction and retention.
- Initial prostate-specific antigen (PSA) was 1.23 ng/mL, with biopsy confirming Gleason 5+5 adenocarcinoma.
Observation:
- The patient received androgen deprivation therapy and whole-pelvic radiotherapy (80 Gy).
- A nadir PSA of 0.40 ng/mL was followed by a rapid increase to 35.92 ng/mL.
- Metastasis to the corpus cavernosum penis occurred, resulting in malignant priapism.
Findings:
- High-grade prostate cancer with low initial PSA is exceptionally aggressive and challenging to treat.
- Standard treatment modalities (androgen deprivation therapy and radiotherapy) demonstrated limited efficacy in this advanced case.
- Rapid disease progression and metastasis occurred despite initial therapeutic interventions.
Implications:
- This case underscores the limitations of current treatment strategies for rare, aggressive prostate cancer subtypes.
- There is a critical need for developing and investigating more effective therapeutic options for such advanced and rapidly progressing malignancies.
- Further research into novel treatment combinations or targeted therapies is essential for improving outcomes in these challenging cases.
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