High levels of serum prostate-specific antigen due to PSA producing follicular non-Hodgkin's lymphoma.
OBJECTIVE
Both carcinoma of the prostate and non-Hodgkin's lymphoma are common in elderly patients. Measurement of serum prostate-specific antigen (PSA) is a frequently used tool to diagnose and monitor prostate carcinoma and is generally specific for diseases of the prostate.


METHODS
We describe a 68-yr-old patient with voiding difficulties and high PSA levels, but without inflammatory or malignant changes upon multiple transrectal ultrasound guided prostate biopsies. Digital rectal examination was normal. Laboratory showed a strongly elevated PSA level (62 microg/L, Immulight 2000); DPC, USA). A CT-scan showed a retroperitoneal process with mass in the right pelvis and infiltration of the bladder wall, suggestive for metastatic prostate carcinoma. Surgical excision of an axillary lymph node set the diagnosis at a stage IV follicular lymphoma, Berard grade I to II in which the majority of neoplastic cells expressed PSA. After lymphoma-specific treatment, there was a positron emission tomography (PET) confirmed complete remission with normal PSA levels (6 microg/L), which still persists.


CONCLUSIONS
Although rare, high PSA levels can be due to the presence of non-Hodgkin's lymphoma. Such a diagnosis should be considered when patients present with lymphadenopathy other than regional prostatic lymphadenopathy.
Oosterheert
Jan Jelrik
JJ
Department of Internal Medicine, Meander Medical Centre, Amersfoort, The Netherlands. j.j.oosterheert@umcutrecht.nl
Budel
Leo M
LM
Vos
Pieter
P
Wittebol
Shulamiet
S
D000368:Aged; D018951:Antigens, CD20 / Q000378:metabolism; D006801:Humans; D008224:Lymphoma, Follicular / Q000097:blood* / Q000473:pathology*; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood*
D018951:Antigens, CD20; D017430:Prostate-Specific Antigen