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Upgrading prostate cancer following proton beam therapy.

Logan JK, Rais-Bahrami S, Merino MJ, Pinto PA - Urol Ann (2015 Apr-Jun)

Bottom Line: Despite this dose-response relationship, radiation-induced changes may be heterogenous among different patients and even within a single tumor.When assessing residual tumor it is important to understand biopsy evaluation in the post-RT setting.We present the case of a poorly differentiated prostate adenocarcinoma following proton beam RT in a 45-year-old man with pre-RT Gleason 4 + 3 = 7 disease diagnosed in the setting of an elevated serum prostate-specific antigen level.

View Article: PubMed Central - PubMed

Affiliation: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

ABSTRACT
Pre- and post-radiation therapy (RT) effects on prostate histology have not been rigorously studied, but there appears to be a correlation between escalating radiation dosage and increasing post-RT histologic changes. Despite this dose-response relationship, radiation-induced changes may be heterogenous among different patients and even within a single tumor. When assessing residual tumor it is important to understand biopsy evaluation in the post-RT setting. We present the case of a poorly differentiated prostate adenocarcinoma following proton beam RT in a 45-year-old man with pre-RT Gleason 4 + 3 = 7 disease diagnosed in the setting of an elevated serum prostate-specific antigen level.

No MeSH data available.


Related in: MedlinePlus

High-power view (×1000) of post-proton beam prostatectomy specimen showing high-grade infiltrating carcinoma with no apparent radiation effect
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Figure 2: High-power view (×1000) of post-proton beam prostatectomy specimen showing high-grade infiltrating carcinoma with no apparent radiation effect

Mentions: A 45-year-old male was diagnosed with cT1c Gleason 4 + 3 = 7 PCa in the setting of a prostate-specific antigen (PSA) of 8.6 ng/mL and was subsequently treated with proton beam RT. His PSA level continually rose from a post-RT nadir of 3.2 ng/mL at 3 months following RT, peaking at 9.39 ng/mL 21 months later. During this observed rise in PSA, at 18 months post-RT, the patient underwent a systematic 12-core transrectal ultrasound (TRUS) biopsy that was found to be negative for cancer, displaying only atypia consistent with RT effect. This prompted multiparametric magnetic resonance imaging (MRI) evaluation of the prostate, which revealed two suspicious intraprostatic lesions and suspected seminal vesicle invasion with no evidence of nodal or bony disease. He then underwent MRI/ultrasound fusion-guided biopsy, which found all six targeted cores demonstrating high-grade disease (five cores with Gleason 4 + 5 = 9 disease) with perineural and seminal vesicle invasion [Figure 1]. He elected to undergo a robotic-assisted salvage radical prostatectomy with extended pelvic LN dissection. Grossly, the prostate gland was atrophied secondary to radiation effect and histologically demonstrated multifocal Gleason 5 + 5 = 10 disease with extracapsular extension and seminal vesicle invasion [Figure 2]. Two of 33 LNs removed were involved by PCa. Post-operative serum PSA evaluations at 1 and 3 months following salvage prostatectomy were stable at 0.07 ng/mL.


Upgrading prostate cancer following proton beam therapy.

Logan JK, Rais-Bahrami S, Merino MJ, Pinto PA - Urol Ann (2015 Apr-Jun)

High-power view (×1000) of post-proton beam prostatectomy specimen showing high-grade infiltrating carcinoma with no apparent radiation effect
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4374273&req=5

Figure 2: High-power view (×1000) of post-proton beam prostatectomy specimen showing high-grade infiltrating carcinoma with no apparent radiation effect
Mentions: A 45-year-old male was diagnosed with cT1c Gleason 4 + 3 = 7 PCa in the setting of a prostate-specific antigen (PSA) of 8.6 ng/mL and was subsequently treated with proton beam RT. His PSA level continually rose from a post-RT nadir of 3.2 ng/mL at 3 months following RT, peaking at 9.39 ng/mL 21 months later. During this observed rise in PSA, at 18 months post-RT, the patient underwent a systematic 12-core transrectal ultrasound (TRUS) biopsy that was found to be negative for cancer, displaying only atypia consistent with RT effect. This prompted multiparametric magnetic resonance imaging (MRI) evaluation of the prostate, which revealed two suspicious intraprostatic lesions and suspected seminal vesicle invasion with no evidence of nodal or bony disease. He then underwent MRI/ultrasound fusion-guided biopsy, which found all six targeted cores demonstrating high-grade disease (five cores with Gleason 4 + 5 = 9 disease) with perineural and seminal vesicle invasion [Figure 1]. He elected to undergo a robotic-assisted salvage radical prostatectomy with extended pelvic LN dissection. Grossly, the prostate gland was atrophied secondary to radiation effect and histologically demonstrated multifocal Gleason 5 + 5 = 10 disease with extracapsular extension and seminal vesicle invasion [Figure 2]. Two of 33 LNs removed were involved by PCa. Post-operative serum PSA evaluations at 1 and 3 months following salvage prostatectomy were stable at 0.07 ng/mL.

Bottom Line: Despite this dose-response relationship, radiation-induced changes may be heterogenous among different patients and even within a single tumor.When assessing residual tumor it is important to understand biopsy evaluation in the post-RT setting.We present the case of a poorly differentiated prostate adenocarcinoma following proton beam RT in a 45-year-old man with pre-RT Gleason 4 + 3 = 7 disease diagnosed in the setting of an elevated serum prostate-specific antigen level.

View Article: PubMed Central - PubMed

Affiliation: Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.

ABSTRACT
Pre- and post-radiation therapy (RT) effects on prostate histology have not been rigorously studied, but there appears to be a correlation between escalating radiation dosage and increasing post-RT histologic changes. Despite this dose-response relationship, radiation-induced changes may be heterogenous among different patients and even within a single tumor. When assessing residual tumor it is important to understand biopsy evaluation in the post-RT setting. We present the case of a poorly differentiated prostate adenocarcinoma following proton beam RT in a 45-year-old man with pre-RT Gleason 4 + 3 = 7 disease diagnosed in the setting of an elevated serum prostate-specific antigen level.

No MeSH data available.


Related in: MedlinePlus