Biochemical Recurrence in Prostate Cancer and Temporal Association to Bone Metastasis

Abstract

Objective: Rare presentation Background: Prostate cancer is a common cancer in men. Radical prostatectomy, i.e., the surgical removal of the entire prostate, is a frequently used option. Biochemical recurrence (BCR), i.e., detectable prostate specific antigen (PSA), is common in some men following such treatment. The timing of BCR to metastatic spread of disease in bones is usually a few years. If the biochemical failure occurs after a longer duration from the time of curative intent, it is generally believed to lead to local recurrence. Case Report: We report on two cases. A 78-year-old male was diagnosed with Gleason 7, prostate cancer in 2001. He subsequently underwent an open radical prostatectomy. Serial post-operative PSA's were undetectable (<0.01 ng/mL) up to 2016. He was diagnosed with a detectable PSA for the first time with a value of 0.3 ng/mL, that year. The PSA continued to rise to a level of 1.1 ng/mL. This rise in the PSA was within a 12-month interval. Subsequent bone scan and bone biopsy detected prostate cancer metastasis in multiple bones. Our second case was a 65-year-old male who underwent a laparoscopic radical prostatectomy in the year 2006 for a biopsy proven prostate cancer with Gleason 3+4=7. Serial post-operative PSA's were undetectable up to 2017. Within a span of 8 months, the PSA rose from 0.3 ng/mL to 1.52 ng/mL. A positron emission tomography scan demonstrated pubic bone lesion indicative of prostate cancer metastasis. Conclusions: BCR can occur a decade after curative intent treatment of prostate cancer. The duration from BCR to detectable metastasis can be shorter. We demonstrated here that the site of recurrence, in such scenarios, can be distant metastasis and not local recurrence alone. Better imaging modalities are needed to identify the spread of prostate cancer at low levels of PSA.

Prognostic value of miR-21 for prostate cancer: a systematic review and meta-analysis

“…Prostate cancer (PCa) is the most commonly diagnosed cancer for males in 105 countries including North and South America, Western Europe and Australia [ 1 ]. The majority of PCa cases are localized disease with very high survival rate after initial treatment (∼100% 5-year survival), but recurrence may occur in about 40% as biochemical recurrence (BCR) or distant metastasis that has a significantly poorer prognosis (∼30% 5-year survival) [ 2 ]. Additionally, some may progress as castration-resistant prostate cancer (CRPC) or develop chemoresistance [ 3 ].…”

Incidental finding of metastatic prostatic adenocarcinoma of frontotemporal bone presenting as subdual hematoma: A case report and review of literature

“…Cranial neurological deficits or nerve palsies caused by prostatic cancer metastasis are uncommon in advanced disease but constitute important clinical characteristics. Skull metastasis can cause symptoms of nervous system debilitation, such as cranial nerve palsy, preferentially causing urological symptoms, facial nerve palsy, multiple cranial nerve palsies, otological symptoms, and ophthalmoplegia [ [2] , [3] , [4] , 14 , 17 ].…”

“…Most skull bone metastases are purely intraosseous lesions limited to the calvarium or base of the skull [ 6 ]. A review of previous reports and literature revealed that metastatic prostate cancer of the temporal bone is rare, especially in the frontotemporal bone [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] ].…”

MiRNAs and radical prostatectomy: Current data, bioinformatic analysis and utility as predictors of tumour relapse

“…Metastasis of a distant organ, typically bone or lymph nodes, is a typical consequence of BCR. The transition from BCR to metastasis may take a long period of time, extending over several years 14,15 . However, it has been shown that biochemical failure is not equal to clinical relapse 14 .…”

“…On the other hand, many viruses, such as mumps virus, HIV and HSV, 7,14 have been found to impair semen quality, and they may directly interact with spermatozoa or affect spermatogenesis by inducing local inflammation. [15][16][17] Previous studies found that SARS, 1 of the 3 epidemic coronaviruses to emerge in the past 20 years and that shows similar clinical presentations to COVID-19, 18 could cause orchitis 19 and focal testicular atrophy. 20 Considering the tens of millions of COVID-19 cases and that men are more vulnerable to COVID-19 than women, [21][22][23] it is imperative to determine the effect of COVID-19 on male reproduction.…”