Bilateral renal metastasis following radical prostatectomy for prostate cancer: a case report

This article reports the diagnosis and treatment of an 81-year-old man with advanced prostate cancer presenting with multiple organ metastases. The patient had undergone laparoscopic radical prostatectomy 5 years prior and received intermittent postoperative endocrine therapy with leuprorelin acetate and bicalutamide. He presented with hematuria, and laboratory evaluation revealed a markedly elevated prostate-specific antigen level (total PSA 274.71 ng/mL, free PSA 63.50 ng/mL). Contrast-enhanced CT demonstrated bilateral renal masses, retroperitoneal lymphadenopathy, and liver metastases. A biopsy of the right renal lesion confirmed metastatic prostate acinar adenocarcinoma, with immunohistochemistry showing PSA (+), Ki67 (40%, indicating high proliferative activity), and succinate dehydrogenase subunit B (SDHB) (+). Following a change in the endocrine therapy regimen to rezvilutamide combined with degarelix, the patient's hematuria significantly improved. This case highlights the critical importance of rigorous postoperative surveillance and timely, standardized endocrine therapy in prostate cancer management. It also contributes to the limited literature on visceral metastases in castration-sensitive prostate cancer (HSPC) and underscores the need for further exploration of optimal treatment strategies for advanced metastatic disease.