Prostate cancer in a 75-year-old man after four decades of testicular androgen deprivation.

Abstract

In a 75-year-old patient referred for mild obstructive symptoms, physical examination revealed a clinically manifest T2B cancer of the prostate (CaP) involving the right lobe, and bilateral testicular atrophy (TA), right cryptorchidism with TA after orchiopexy at age 10, and left mumps orchitis with secondary atrophy at age 35). Since the age of 35, the patient had a limited sexual life and fathered no children. Transrectal ultrasonography demonstrated a small prostate (21 cm3) with a large hypoechoic zone in the right lobe, an isoechoic left lobe and no sign of capsular/seminal involvement. Three biopsies of the right lobe demonstrated a cancer (Gleason 4-3; score 7) of the right lobe, 3 biopsies of the left lobe showed an atrophic prostate with slight intra-acinar hyperplasia and moderate dysplasia. Morphometric studies showed these findings to be consistent with long-standing androgen deprivation. Serum prostate-specific antigen (PSA) was 8.7 ng/ml, whereas serum testicular androgens were within the castrate value (serum testosterone 0.2 ng/ml, dihydrotestosterone less than 0.05 ng/ml). Serum LH and adrenal androgens were within normal ranges. Bone scan was negative and NMR demonstrated no nodal enlargement. Considering the age of the patient, antiandrogen therapy was given (cyproterone acetate 50 mg t.i.d.). The patient reported marked improvement at 3 and 6 months of follow-up and PSA fell to 1 ng/ml at month 6. However, repeat rectal exams and ultrasonography showed no dramatic modification of the gland. The patient has since been lost to follow-up. Two conclusions may be drawn from this observation. Testicular androgen deprivation at age 35 although leading to prostatic atrophy does not prevent the development of CaP.(ABSTRACT TRUNCATED AT 250 WORDS)