A 63-year-old patient was diagnosed in the three months prior to admission of differentiated adenocarcinoma prostate glands Gleason 1+1, stage IV (bone metastases), after consultation for generalized prostatic syndrome and bone pain.
On that date, he underwent PSA, prostate biopsy, and bone scintigraphy that showed blastic lesions in the scapula, shoulder and ribs.
The patient was treated with complete androgen deprivation (CAD) with subsequent analytical control, normalization of PSA.
After the three months mentioned above, the patient came to the emergency room for severe bone pain, predominantly in the lumbar spine, hypercalcemia and renal failure, which did not present previously.
Treatment was initiated with analgesia on demand, fluid therapy, zoledronic acid, corticosteroids and diuretics.
An abdominal-pelvic CT scan showed a moderately enlarged prostate, an incidental right renal cortical cyst, lytic lesions of the dorsal and lumbar spine, associated with a left rib mass and in the ala.
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Laboratory tests showed normalization of PSA, some degree of renal failure (Creatinin 1.8), normalization of calcemia after specific treatment and 24-hour urine proteinuria.
High suspicion of multiple myeloma in a patient with good biochemical evolution to prostatic carcinoma BAC, its great clinical and radiological deterioration and the appearance of renal failure, cytopuncture was decided
The cytology of the same was positive for multiple myeloma, later confirmed with a bone marrow biopsy.
Treatment was initiated with melphalan and corticoids, maintaining the CR-BSI, with poor response in her illness.
Subsequently, the patient was treated with VAD (Vincristine, Adriamycin and dexamethasone) and BAC with great improvement.
After 3 months, a new control bone marrow biopsy was performed, evaluating an important histological response in patients with myeloma.
Currently the patient maintains chemotherapy treatment according to the scheme mentioned above and CR-BSI with good evolution, maintaining normalization of PSA, calcemia and renal function.
