PMC8107685_01
Radiographic change pre- and post-therapy. The results of CT scan showed metastatic tumors in bilateral lungs at diagnosis (A) and no visible metastatic tumors in the lungs after androgen deprivation therapy and six cycles of chemotherapy (C); Bone scan showed multiple metastases in the scapulae, ribs, sacroiliac joints, hip joints, thoracic vertebrae, lumbar vertebrae, etc at diagnosis (B) and the metastatic tumors in the bones lessened significantly (D).
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Further ultrasound examination suggested PCa with the right seminal vesicle invasion, chest computed tomography (CT) scan indicated metastatic tumors in bilateral lungs and enlarged lymph nodes in the mediastinum ( Figure 1A ), bone scan demonstrated multiple metastases in the scapulae, ribs, sacroiliac joints, hip joints, thoracic vertebrae, lumbar vertebrae, etc ( Figure 1B ). After six cycles, chest CT and bone scan showed that the metastatic tumors in the lungs were surprisingly disappeared, and the metastatic tumors in the bones lessened significantly ( Figures 1C, D ), along with a remarkable reduction in PSA level (< 2 ng/ml).
CT/MRI scan showed widespread metastases in the lungs (A), liver, bilateral adrenals (B), thoracic and lumbar vertebrae (C), and pelvis bones (D).
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CT/MRI scan showed widespread metastases in the lungs, liver, bilateral adrenals, thoracic and lumbar vertebrae, and pelvis bones ( Figure 2 ), the PSA level was higher than 400 ng/ml.
Histopathology of prostate and liver tumor. No visible tumor cell in prostate specimen (A), and expression of P63 (B) and 34BE12 (C) surrounding the gland. Visible prostate adenocarcinoma in liver tumor (D) with expression of AR (E), PSA (F) and negative Syn (G) and CgA (H), Hepatocyte (I).
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Consequently, no tumor cell was observed in the specimen of prostate, immunohistochemical stains showed expression of P63 and 34BE12 surrounding the gland ( Figure 3 ). In the specimen of liver tumor, prostate adenocarcinoma was observed and the expressions of AR, PSA, P504S, MLH1, MSH2, MSH6, PMS2 were observed in the immunohistochemical stains, with ERG, Syn, CgA, hepatocyte, arginase-1, and PSAP not observed ( Figure 3 ).
Overall process of disease progression, related treatment and changes of the PSA level. The upper graph shows changes of the PSA level, the treatment course is in the middle and the progression of the disease is shown in the bottom. ADT, androgen deprivation therapy; DOC, docetaxel; IAD, intermittent androgen deprivation; ABI, abiraterone; NA, not available.
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The overall process of disease progression, treatment course and changes of the PSA level were provided below in detail ( Figure 4 ).