Isolated prostate cancer soft tissue recurrence 10 years after radical prostatectomy

Abstract

In advanced disease, prostate cancer is well known to invade locally as well as metastasise to distant locations. Metastases occur commonly in lymph nodes and bone but have also been known to involve certain visceral organs, particularly the lungs. Involvement of soft tissue by metastases is far less common, particularly in the context of cancer recurrence. We present the case of a male aged 68 years who presented with a rising prostate-specific antigen (PSA) 10 years after radical prostatectomy (RP). The PSA increased despite salvage radiotherapy and was ultimately found to be caused by a PSA secreting prostate cancer soft tissue mass in the suprapubic region. Surgical resection of the mass caused a sharp decline in the PSA to negligible levels. This case highlights the need for ongoing surveillance post-RP and the potential for prostate cancer recurrence in the soft tissue that is refractory to routine salvage radiotherapy.

Keywords: Prostate; Surgical oncology.

Figure 1

T2-weighted MRI scan (axial and sagittal views; mass demonstrated by white arrow).

Figure 2

(A, B) Original radical prostatectomy specimen; (A) acinar adenocarcinoma (H&E 40x), (B) ductal adenocarcinoma (H&E 40x). (C, D) Suprapubic mass; (C) malignant glands showing Gleason grade 5 pattern of ductal morphology with a cribriform architecture and comedo necrosis (H&E 100x), (D) diffusely positive staining with prostate-specific antigen immunohistochemistry (100x).

Figure 3

Prostate-specific antigen (PSA) trend over time. Note peak PSA prior to salvage radiotherapy and excision of suprapubic mass (0.49 and 3.15, respectively) in comparison to nadir PSA postsalvage radiotherapy and excision of suprapubic mass (0.22 and 0.07, respectively).