A case of rapidly progressing prostate cancer diagnosed 20 months after holmium laser enucleation of the prostate

Abstract

A 65-year-old man presented for treatment of benign prostatic hyperplasia. His prostate volume was 50cm3 and serum prostate-specific antigen was 1.93ng/mL. Digital rectal examination showed no malignant nodules on the surface of the prostate. Holmium laser enucleation of the prostate was performed. The enucleated tissue was 21g and pathological examination revealed no malignancy. Serum prostate-specific antigen had increased continuously to 6.38ng/mL and prostate biopsy was performed 20months after holmium laser enucleation of the prostate. Pathological examination confirmed an adenocarcinoma of the prostate with a Gleason score of 9 (4 + 5). Computed tomography and bone scintigraphy demonstrated multiple bone metastases and we made a diagnosis of prostate cancer, cT2aN0M1b. After 3months on androgen deprivation therapy, he developed castration-resistant prostate cancer and died within 13months after diagnosis of prostate cancer, despite receiving sequential therapy including enzalutamide, docetaxel and abiraterone. In our case, prostate-specific antigen was not measured until 13months after holmium laser enucleation of the prostate, after which prostate-specific antigen rose from 1.93 to 4.09ng/mL. This report provides an important implication of continuous monitoring of prostate-specific antigen after holmium laser enucleation of the prostate to detect prostate cancer early.