Metastatic prostate cancer (with prostate-specific antigen of 9996) presenting as obstructive jaundice.
A 78-year-old man admitted with clinical jaundice and pelvic pain had a total bilirubin level of 6.56 mg/dL, an alkaline phosphatase level of 855 U/L, and a prostate specific antigen (PSA) level of 9996 ng/mL. A computed tomogram demonstrated marked retroperitoneal, peripancreatic, periceliac, and periaortic lymphadenopathy. A bone scan revealed increased radiolabeled technetium uptake in the pelvis, vertebral column, parietooccipital region, ribs, and appendiceal skeleton. A biopsy of one pelvic lesion revealed metastatic prostate cancer. This man's obstructive jaundice and bone pain had a dramatic response to treatment with a gonadotropin-releasing hormone analog (leupro lide) and antiandrogen (bicalutamide). All bone pair and clinical signs of jaundice disappeared in 1 week His total bilirubin decreased to 0.84 mg/dL by 2 weeks His PSA values reflected this clinical response, decreasing to 4022 ng/mL in 1 week, 2680 ng/dL after 2 weeks and 1028 ng/mL after 1 month of the above therapy.
Cole
A
A
Department of Internal Medicine, University of South Florida for Health Sciences, and James A. Haley Veterans Hospital, Tampa 33647, USA.
Mendelblatt
D
D
Aguayo
J
J
Mathew
A
A
Martin
E
E
Vesely
D L
DL
D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D000726:Androgen Antagonists / Q000008:administration & dosage; D000813:Anilides / Q000008:administration & dosage; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001663:Bilirubin / Q000097:blood; D001859:Bone Neoplasms / Q000188:drug therapy / Q000556:secondary; D002779:Cholestasis / Q000209:etiology*; D006801:Humans; D016729:Leuprolide / Q000008:administration & dosage; D008207:Lymphatic Metastasis; D008297:Male; D009570:Nitriles; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D014105:Tosyl Compounds; D016896:Treatment Outcome
D000726:Androgen Antagonists; D000813:Anilides; D018931:Antineoplastic Agents, Hormonal; D009570:Nitriles; D014105:Tosyl Compounds; C053541:bicalutamide; D000469:Alkaline Phosphatase; D017430:Prostate-Specific Antigen; D016729:Leuprolide; D001663:Bilirubin