A 66-Year-old Man With Prostate-specific Antigen Recurrence and Lung Mass After Radical Prostatectomy

Abstract

A67-year-old white male patient with a past medical history of prostate cancer status post nervesparing radical retropubic prostatectomy, malignant fibrohistiocytoma of the left hand, and basal cell carcinoma of the ear status post resection, presented for a follow-up visit to his urologist and was found to have an increased prostate-specific antigen (PSA). The patient had initially undergone a radical prostatectomy in December 1989 when he was 60 years old. Final pathology revealed a Gleason 6 adenocarcinoma with a focus of prostatic ductal carcinoma, organ confined (pT2) with negative margins (Figs. 1A, 1B). Initial postoperative PSA was undetectable, but in 1991, it became detectable and continued to increase to 0.8 in 1994. Bone scan and imaging of the pelvis were negative for metastatic disease. The patient received radiation therapy to his prostatic bed beginning July 1994 when the patient was 65 years old. His postradiation PSA was 0.8 and initially decreased, but in January 1997, it was 2.1. The patient denied any weight loss, fevers or chills, chest pain or shortness of breath, abdominal pain, bone pain, increased urinary frequency, urgency, or hesitancy, dysuria, or hematuria. He was having regular bowel movements. He was a lifetime nonsmoker. On examination, the patient was afebrile and his vital signs were stable. He was alert and generally appeared well. He had no cervical or axillary adenopathy. Lungs were clear to auscultation bilaterally. His abdomen was soft, nontender, and nondistended. He had a well-healed midline surgical scar. Rectal examination showed no palpable nodularity in the prostatic bed and good sphincter tone. Extremities were warm and well-perfused without edema, clubbing, or cyanosis. His laboratory test