PMC10022659_01
69-year-old male with advanced prostate cancer. Baseline sagittal (A) and axial (B) T2W MRI performed after transurethral resection show a large mass (total lesion volume of 282cc) occupying the whole prostate with rectum, bladder with diffusion restriction on ADC map. Post-treatment follow up sagittal (C) and axial (D) T2W MRI show a gradual decrease in size of the lesion (total lesion volume 11.4cc) without evidence of rectum and bladder involvement. T2W, T2 weighted image; ADC, apparent diffusion coefficient.
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Magnetic resonance imaging (MRI) of the pelvis that was performed after transurethral resection revealed circumferential involvement of the rectum with extension into the base of the penis with no lymphadenopathy ( Figure 1 ). Multiparametric MRI of the prostate was obtained after 2 cycles of treatment with pembrolizumab plus ADT and showed a decrease in size in the intraprostatic lesion, from 8.9 cm to 2.8 cm ( Figure 1 ).
Graph of the patient's PSA response to treatment with degarelix and pembrolizumab. The patient was treated with degarelix (denoted at Day 0) when his PSA was 10.92 ng/mL. Four days later, he was given pembrolizumab when his PSA was 6.9 ng/mL. His symptoms from the prostate mass largely resolved within 24 hours of the first dose of pembrolizumab. The PSA became undetectable at day 46 from start of degarelix.
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Within one month of initiation of therapy, his serum PSA level was undetectable ( Figure 2 ).