Case Presentation II - uroleb.org sensitive... · Case Presentation II Metastatic-Hormone sensitive...
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Case Presentation II
Metastatic-Hormone sensitive Prostate cancer
Imad Nabih Farhat, MD FEBU RHUH & Trad Hospital
09/04/16
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Case presentation 1
K.I a 57 years old male pt Known to have HTN, CAD S/P CABG presented with AUR
PMSH: Hematuria, dysuria since 1 week
constipation, incontinence intermitency, nocturia.
Patient noted weight loss of 12 kg in 3 months
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P/E : DRE big and hard prostate Lab test : Cbcd : 9000, High creat Supra pubic catheter (foley<0) Ct scanner abdomen pelvis done
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Ct abdo pelvis
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Ct scanner abdomen pelvis: Bilateral uretero hydronephrosis
Multiple enlarged para aortic LN, iliac, intenal, external, presacral
Multiple Sclerotic Lesions : sacral vertebra, Iliac bones, left femoral Head
PSA : 1400
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Cystoscopy and cytostomy done Prostate biopsy showed: Prostatic adenocarcinoma involving
both right and left lobes . Gleason score 9 (5+4)
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n Hormonal therapy began Leuprolide 45 + Bicalutamide 50
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6 month later :
Patient developed CKD , is on
hemodialysis three times per week
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Routine follow up we investigate: 1-Ct abdo pelvis : Decrease in the LN left external iliac 6 x 7,5 x 5,5 cm
to 5x3x2 cm Increase in the multiple sclerotic
lesions 2-PSA : 38 ng/ml Patient is feeling better, No pain.
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Next
Cystoscopy + TURBT (superficial) Surgical Castration done (upon his
choice) Chemotherapy ( Docetaxel)
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What is next if patient developed
castration resistance …..?
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Case presentation 2
M.S an 84 years old male pt previously healthy presented with dysuria, hesitency, interimitency and Constipation +++
2 episodes of gross hematurie PMSH : TURP 25 yrs ago No follow up DRE : left lobe enlargement (Soft)
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Lab test ; normal, U/A : rbc +++ Psa : 19 ng/ml Ct scanner abdomen pelvis
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n
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Cystoscopy: - Big prostate - Trabeculated bladder and
diverticulum pouch in posterior wall no bladder tumor
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York Mason aproach
-Excision of presacral mass , release
adhesion from lateral wall of rectum and sigmoid.
-mass was severely adherent to
posterior wall of prostate -TURP done
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-Pathology of presacral mass : Hematoma surrounded by thick
fibrohyalin tissue with poorly differentiated adenocarcinoma
(Immuno + for PSA) -Pathology of TURP : Prostate involved by adenocarcinoma
arround 10 % of the submited tissue .
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Next
n Wawa n Hormonal therapy n Hormonal + Chemo (Docetaxel)