PMC5761507_01
Trend of PSA over time. # marks salvage radiation to prostate bed and pelvis; & marks starting AR targeted therapy with abiraterone; *marks SBRT treatment to metastatic para-aortic lymph node.
omx078f01.jpg
PMC5761507_01_omx078f01.jpg
omx078F1
He was offered adjuvant androgen deprivation therapy (ADT) in the form of leuprolide which maintained his PSA at undetectable levels for ~3 years when it increased to 1.9 ng/ml (Fig. 1). His PSA continued to rise to 2.05 ng/ml along with enlarging external iliac lymph nodes (Fig. 1). A follow-up CT scan 4 months later showed an increase in the size of the lymph node to 1.5 cm with PSA rising to 2.74 ng/ml (Figs 1 and 2 B). Six months post treatment, CT scan showed marked decrease in the size of the para-aortic lymph node and decline in PSA (Figs 1 and 2C).
Computed Tomography (CT) scans showing enlarging metastatic para-aortic lymphadenopathy (A) 4 months prior to SBRT, (B) at SBRT; and then responding to treatment and (C) 4 months after SBRT.
omx078f02.jpg
PMC5761507_01_omx078f02.jpg
omx078F2
CT scan showed an enlarging para-aortic lymph node (Fig. 2A). A follow-up CT scan 4 months later showed an increase in the size of the lymph node to 1.5 cm with PSA rising to 2.74 ng/ml (Figs 1 and 2 B). Six months post treatment, CT scan showed marked decrease in the size of the para-aortic lymph node and decline in PSA (Figs 1 and 2C).
SBRT for a LEFT iliac lymph node. The prescribed dose was 50 Gy in 5 Gy fractions. Isodose lines are shown in (A, axial; B, sagittal and C, coronal). The dose volume histogram is shown in D.
omx078f03.jpg
PMC5761507_01_omx078f03.jpg
omx078F3
The patient then received SBRT 50 Gy in 10 fractions to the para-aortic lymph node (Fig. 3).