Introduction: Prostate cancer is the sixth most common cancer in the world, the second most common cancer among men, and the most common cancer in men in Europe. Metastatic prostate cancer among young patients represents the rarest of the newly diagnosed prostate cancer, with few reports of cases with a longer survival.
Case presentation: We present the case of a 59 year-old male who was referred with back pain over the last month. Digital rectal examination highlighted an enlarged and totally indurated prostate of 4x4.5 cm, while abdominopelvic X-rays showed osteoblastic metastases in the spine and pelvis bones. Laboratory examinations revealed a Prostate Specific Antigen level of 7941 ng/ml. Prostate biopsy histology showed a bilateral prostate cancer with a Gleason score of 8. Androgen deprivation therapy and daily administration of biphosphonates were prescribed. After two years of treatment, the Prostate Specific Antigen level decreases to 8 ng/ml.
Conclusions: We reported the highest Prostate Specific Antigen level in a patient under 60 years old with metastatic prostate cancer. Prostate cancer remains an important public health problem due to the aggressiveness of the disease and advanced stage upon diagnosis. Prostate Specific Antigen is mandatory to evaluate, to have a reference level in order to prevent metastatic prostate cancer in young patients at diagnosis.
3. Benoit RM, Naslund MJ. The socioeconomic implications of prostate-specific antigen screening. Urol Clin North Am. 1997;24(2):451–458.
4. Krpina K, Markić D, Rahelić D, Ahel J, Rubinić N, Španjol J. 10-year survival of a patient with metastatic prostate cancer: Case report and literature review. Arch Ital Urol Androl. 2015;87(3):252-3. doi: 10.4081/aiua.2015.3.252.
5. Slipman CW, Patel RK, Siegelman ES, et al. Metastatic prostate cancer to the spine and a PSA of 5666: a case report. Pain Physician. 2001;4(4):317–321.
6. Persec Z, Persec J, Sović T, Romic Z, Bosnar Herak M, Hrgovic Z. Metastatic prostate cancer in an asymptomatic patient with an initial prostate-specific antigen (PSA) serum concentration of 21,380 ng/ml. Onkologie. 2010;33(3):110–112. doi: 10.1159/000277743.
7. Dantanarayana ND, Hossack T, Cozzi P, et al. Men under the age of 55 years with screen detected prostate cancer do not have less significant disease compared to older men in a population of patients in Australia. BMC Urol. 2015;15(1):124. doi: 10.1186/s12894-015-0117-3.
8. Andriole GL, Crawford ED, Grubb RL, et al. Prostate cancer screening in the randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial: mortality results after 13 years of follow-up. J Natl Cancer Inst. 2012;104(2):125–132. doi: 10.1093/jnci/djr500.
9. Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360(13):1320–1328. doi: 10.1056/NEJMoa0810084
10. Buzzoni C, Auvinen A, Roobol MJ, et al. Metastatic Prostate Cancer Incidence and Prostate-specific Antigen Testing: New Insights from the European Randomized Study of Screening for Prostate Cancer. Eur Urol. 2015;68(5):885–890. doi: 10.1016/j.eururo.2015.02.042.
11. Schröder FH, Hugosson J, Carlsson S, et al. Screening for prostate cancer decreases the risk of developing metastatic disease: findings from the European Randomized Study of Screening for Prostate Cancer (ERSPC). Eur Urol. 2012;62(5):745–752. doi: 10.1016/j.eururo.2012.05.068.
12. Woolf SH. Public health perspective: the health policy implications of screening for prostate cancer. J Urol. 1994;152(5 Pt 2):1685–1688.
13. Sun M, Choueiri TK, Hamnvik O-PR, et al. Comparison of Gonadotropin-Releasing Hormone Agonists and Orchiectomy: Effects of Androgen-Deprivation Therapy. JAMA Oncol. 2016;2(4):500-507. doi: 10.1001/jamaoncol.2015.4917.
14. Nyman CR, Andersen JT, Lodding P, Sandin T, Varenhorst E. The patient’s choice of androgen-deprivation therapy in locally advanced prostate cancer: bicalutamide, a gonadotrophin-releasing hormone analogue or orchidectomy. BJU Int. 2005;96(7):1014–1018.
15. Leidinger P, Hart M, Backes C, et al. Differential blood-based diagnosis between benign prostatic hyperplasia and prostate cancer: miRNA as source for biomarkers independent of PSA level, Gleason score, or TNM status. Tumour Biol. 2016;37(8):10177-10185. doi: 10.1007/s13277-016-4883-7.