Successful Diagnosis and Treatment of Occult Prostate Cancer Despite Multiple Negative Prostate Biopsies and Negative Prostate MRIs - Cancer Network
ABSTRACT Prostate-specific antigen (PSA) values above 100 ng/mL often suggest metastatic prostate cancer. We present the case of a patient with a PSA of 110 ng/mL, 4 negative prostate biopsies, and 4 negative prostate MRIs. After his fifth MRI revealed a PI-RADS 5 lesion, he underwent his fifth transrectal biopsy; this revealed Gleason 3 + 4 = 7. He was found to have organ-confined pT2 disease on subsequent radical prostatectomy pathology. This case highlights that there may be no PSA for which one can assume metastatic disease with certainty. Depending on life expectancy, patients with extremely elevated PSA may still warrant a full staging workup Introduction And Initial Presentation A man, aged 73 years, presented to our care in early 2021 with a prostate-specific antigen (PSA) of 110 ng/mL after 4 negative prostate biopsies and 4 negative prostate MRIs. His journey had begun in 2002 when his PSA was 3 ng/mL. Two years later, in 2004, at a PSA level of 3.8 ng/mL, he had his first tr...