Aggressive Prostate Cancer After a 14-Year Gonadotropin Therapy: A Case Report.

Autor:	Yoshioka F; Department of Urology, Osaka Central Hospital, Osaka, JPN., Kiuchi H; Department of Urology, Osaka Central Hospital, Osaka, JPN., Soda T; Department of Urology, Osaka Central Hospital, Osaka, JPN., Tsujimura A; Department of Urology, Juntendo University Urayasu Hospital, Urayasu, JPN., Sekii K; Department of Urology, Osaka Central Hospital, Osaka, JPN.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Jun 19; Vol. 16 (6), pp. e62672. Date of Electronic Publication: 2024 Jun 19 (Print Publication: 2024).
DOI:	10.7759/cureus.62672
Abstrakt:	A 40-year-old man with a four-year history of infertility was referred to our department. The semen analysis revealed low motility, and the blood test showed low luteinizing hormone levels. Gonadotropin therapy was initiated upon the diagnosis of hypogonadotropic hypogonadism. During treatment, serum prostate-specific antigen (PSA) was consistently low (1.4-1.9 ng/mL). Fourteen years after the start of treatment, at 54 years old, PSA was abruptly elevated (3.5 ng/mL), and gonadotropin therapy was discontinued due to possible prostate cancer. After cessation, PSA decreased temporarily but then gradually increased to 7.6 ng/mL, but the patient requested PSA follow-up. Twenty years after discontinuation of gonadotropin therapy, PSA increased sharply to 65.9 ng/mL. A prostate biopsy revealed adenocarcinoma with a Gleason score of 4+5. A bone scan showed multiple bone metastases, leading to an advanced prostate cancer (cT4N0M1b) diagnosis. Six months after androgen deprivation therapy, PSA increased again. Under castration-resistant prostate cancer diagnosis, enzalutamide and radium-223 chloride were administered. After treatment, bone metastases were significantly reduced, and PSA decreased. Although gonadotropin and testosterone replacement therapy may not increase prostate cancer risk, patients with low testosterone levels may develop high-grade advanced prostate cancer. Therefore, PSA should be monitored regularly; if PSA levels are continuously elevated, even below 4 ng/mL, a close examination of cancer may be warranted. Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Yoshioka et al.)
Databáze:	MEDLINE
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