INTRODUCTION: The main tool for the diagnosis and monitoring of prostate cancer is PSA (Prostate-Specific Antigen). The follow-up of high-risk prostate carcinoma is based on periodic analytical controls and these determine the need to request additional tests in case of suspicion of metastatic disease. We present the clinical case of a patient with analytical control in the range of normality and high metastatic load at the request of tests for symptomatic repercussion.
CLINICAL FINDINGS: A 70-year-old male patient with a history of dyslipidemia and sleep apnea syndrome. By PSA elevation of 6.54 ng / ml, prostate biopsy was performed in 2011 diagnosing Gleason 5 + 4 adenocarcinoma in 5 of 10 cylinders. Stadium T2b. Extension study was negative for distant disease.
DIAGNOSIS AND TREATMENT: Radiation therapy was decided upon receiving 76 Gy (Grays) with androgen deprivation therapy for 4 years. PSA nadir was 0.02 and testosterone in castration range. In oncological follow-up, PSA <2 ng / ml were observed in all controls. Six years after diagnosis, the patient starts with asthenia and bone pain, so complementary tests were performed. PSA was 1.4 ng / ml. In the computed tomography (CT) found multiple nodules of different size in both pulmonary fields, suggestive of metastasis. In brain CT, a single dural lesion was observed with bone involvement in the left temporal region. In bone scintigraphy 8 metastatic bone lesions. Treatment with docetaxel was indicated.
OUTCOMES AND FOLLOW UP: Patient diagnosed with metastasic prostate cancer resistant to castration. Ten cycles with docetaxel were proposed. Control PSA 10.06 ng / ml. Testosterone 0.3 nmol / L. During the 4th cycle worsening symptoms with Performance Status of 2 and radiological oncological progression. Exitus a one week later due to nosocomial pneumonia.
The oncological monitoring of patients with high-risk prostate cancer is based on analytical control with PSA, and depending on their values or the patient's symptoms, request radiological tests. Sometimes this control may be insufficient, such as the clinical case presented, with high metastatic volume and PSA values lower than those considered as progression.
