title: Metastatic prostate cancer in an asymptomatic patient with an initial prostate-specific antigen (PSA) serum concentration of 21,380 ng/ml.
abstract: BACKGROUND
  Prostate cancer is the second most common cause of cancer death in men, being responsible for approximately 13% of all cancer deaths. Due to the high specificity for prostate tissue, prostate-specific antigen (PSA) is the primary serum tumor marker for prostate cancer. To our knowledge, in published data, the highest reported PSA level on initial presentation was 5,666 ng/ml.
  
  
  METHODS
  We present a 64-year-old Caucasian man with no specific urologic or pain symptoms and with an initial PSA serum value of 21,380 ng/ml. Initial laboratory studies showed chronic anemia and elevated alkaline phosphatase, most likely from bone marrow infiltration due to metastatic disease. Prostate biopsies diagnosed an adenocarcinoma of the prostate (Gleason score 9). Computed tomography (CT) showed multiple liver metastases with retroperitoneal lymph nodes of up to 1 cm. The prostate was moderately enlarged (estimated weight 35 g). Both kidneys were normal (no hydronephrosis present). A bone scintigraphy demonstrated diffuse osseous metastasis. Treatment was initiated with bilateral subcapsular orchiectomy and bicalutamide therapy in an effort to create total androgen blockade. After 3 months of follow-up, the serum concentration of PSA was 29 ng/ml.
  
  
  CONCLUSIONS
  This case presents an asymptomatic prostate cancer patient with bone and liver metastasis, enlarged retroperitoneal lymph nodes and the highest PSA level published to date.
authors.affiliation: Department of Urology, University Hospital Dubrava, Zagreb, Croatia.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Persec
authors.forename: Jasminka
authors.initials: J
authors.lastname: Persec
authors.forename: Tomislav
authors.initials: T
authors.lastname: Sović
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Romic
authors.forename: Maja
authors.initials: M
authors.lastname: Bosnar Herak
authors.forename: Zlatko
authors.initials: Z
authors.lastname: Hrgovic
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood*; D001859:Bone Neoplasms / Q000097:blood* / Q000556:secondary*; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000556:secondary*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen