Abstract
A 74-year-old man was initially diagnosed as having cT4N0M0 and Gleason score 5+4 prostate adenocarcinoma in 2012. Systemic therapy was initiated with luteinizing hormone-releasing hormone (LH-RH) agonist and bicalutamide, and serum prostate-specific antigen (PSA) levels fell to a nadir of 0.02 ng/ml from 25.55 ng/ml.After 3 years of initial treatment, the patient presented with metastatic castrate-resistant prostate cancer (mCRPC) with extensive bulky lymphadenopathy and a serum PSA of 4.81 ng/ml. Open biopsy of the left supraclavicular lymph node revealed metastasis by poorly-differentiated adenocarcinoma of prostatic origin. He continued to receive LH-RH agonist and bicalutamide and underwent seven courses of docetaxel (DOC) chemotherapy plus prednisolone. Computed tomography showed partial response in all but one metastatic pelvic lymph node, which gradually increased in size. The mCRPC response to DOC was heterogeneous, and DOC chemotherapy was stopped because of toxicity and progressive disease.Second-line hormonal therapy with enzalutamide and LH-RH agonist was started and after 6 months, computed tomography revealed complete response in the metastatic lymph nodes based on response evaluation criteria in solid tumors (RECIST); PSA levels decreased to 0.01 ng/ml. The patient has been in complete remission for 28 months.
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