case_images: PMC10206126_01
case_images: (A) Pelvic MRI Prostate cancer with bladder, bilateral seminal vesicle gland and peritoneum involvement, bilateral ureter and sigmoid colon involvement, secondary pelvic lymph node metastasis. (B) The abdominal computed tomography showed the tumor involved retroperitoneal lymph nodes.
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case_images: Total prostate specific antigen (TPSA) was 14.83 ng/ml, and magnetic resonance imaging (MRI) showed a prostate volume of 5.4 cmx7.6 cmx5.0 cm, considering prostate cancer with bladder, bilateral seminal vesicle, and peritoneal involvement, bilateral ureteral and sigmoid involvement, secondary pelvic lymph node metastasis, bilateral ureteral dilatation, and bilateral hydronephrosis ( Figure 1A ). Renal dynamic imaging showed severely impaired bilateral renal function, right renal function better than the left, retroperitoneal lymph node metastases progressed, and compression of both ureters ( Figure 1B ).
case_images: X axis: Admission time; Y axis: Blood tPSA ; The trend of tPSA changes after taking various methods during the treatment.
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case_images: Blood tPSA was 6.48 ng/ml ( Figure 2 ) at 2 weeks and 9.12 ng/ml at 4 weeks of treatment, and tPSA fluctuated significantly.
case_images: X axis: Admission time; Y axis: testosterone ; In general, castrate levels of testosterone were maintained after treatment.
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case_images: Overall, the patient had testosterone less than 2.5 ng/dl and maintained castrate levels ( Figure 3 ), but both tPSA and imaging studies suggested disease progression.
case_images: (A) At the end of the chemotherapy cycle, CT showed significant reduction of retroperitoneal lymph nodes. (B) Pelvic MRI Pelvic organ involvement and multiple pelvic lymph node metastasis were more advanced than before.
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case_images: At the end of 10 cycles of chemotherapy, CT showed that retroperitoneal lymph nodes basically disappeared ( Figure 4A ), tPSA decreased to 0.564 ng/ml, and blood testosterone was < 2.5 ng/dl, and the DJ tube and right nephrostomy tube were removed. MRI showed pelvic organ involvement and multiple pelvic lymph node metastases progressed than before ( Figure 4B ).The patient refused to receive chemotherapy again and chose oral abiraterone + prednisone regimen.