ArticleAnnals of medicine and surgery (2012)2026
Advanced prostate cancer presenting as bulky loco-regional disease without distant metastasis: a case report with review of the management - What is the optimal treatment?
Article in Annals of medicine and surgery (2012), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Prostate cancer is the most common solid tumor in males, with a significant incidence worldwide. PSA screening and digital rectal examination are standard screening methods, yet some patients present with advanced disease because of delayed detection. We present the case of locally advanced prostate cancer presenting with large pelvic lymphadenopathy as a unique presentation. Case Presentation: A 65-year-old man presented with lower urinary tract symptoms and a significantly elevated PSA of 226 ng/mL. Physical examination revealed a large, non-tender pelvic mass. Multiparametric MRI revealed a large PIRADS 5 lesion in the prostate (5.6 × 3.6 cm) with extensive invasion, including seminal vesicles and the right posterior bladder wall. PET PSMA scan showed extensive regional lymph node involvement but no distant metastasis. Prostate biopsy showed Gleason 8 (4 + 4) adenocarcinoma. The patient was classified as having Stage IVa (T3bN1M0) prostate cancer and underwent treatment with androgen deprivation therapy (ADT), androgen receptor pathway inhibitors, and intensity-modulated radiotherapy (IMRT), targeting the prostate and pelvic lymph nodes. The patient achieved a PSA at 6 months 1.5 ng/mL, and <0.006 ng/mL at 15 months with significant regression of the pelvic mass and lymphadenopathy. Discussion: Conclusion: This case presents a unique manifestation of prostate cancer as a large pelvic mass. It emphasizes the importance of early screening and advanced treatment strategies to enhance patient outcomes.
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