A 62-year-old man presented with progressive edema in both lower extremities, genital and inguinal region of approximately seven months duration, without any other accompanying symptoms.
Her past medical history included only arterial hypertension and non-complicated nephritic colic.
In the physical examination, the presence of edema of hard consistency in the pituitary zone, including penis, scrotum and inguinal region, which extended by both lower limbs and was more evident on the left, was noteworthy.
There were no skin lesions or laterocervical or axillary lymph nodes.
Palpation of probable inguinal lymphadenopathy.
A rectal examination showed an enlarged, hard and non-painful prostate.
Laboratory tests including biochemistry, blood count, proteinogram, coagulation and 24-hour urine protein excretion were normal.
Tumor markers were requested, highlighting a PSA of 100 micrograms/l.
Both abdominal ultrasound and CT showed multiple paraaortic retroperitoneal lymphadenopathies in both iliac chains as well as an enlarged prostate.
The patient was consulted with the Urology Department and a conclusive prostatic biopsy was performed for adenocarcinoma of the prostate and inguinal adenopathy, which showed invasion by prostatic adenocarcinoma.
The immunohistochemical study revealed an intense positivity for alkaline phosphatase, the pro-specific antigen (PSA) and for androgen receptors.
Bone scintigraphy showed increased retroauricular uptake and in the spinous process and C3 auricular cartilage.
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Hormonal treatment was initiated with antiandrogens and LHRH analogues.
The presence of bone metastases is called zoledronic acid.
Nine months after treatment, the patient was clinically stable with no changes in physical examination.
PSA was 4.6 micrograms/l.
