pathophysiology case scenario question

Question

A 72-year-old man has a radical prostatectomy for localized prostate cancer. After surgery his PSA level was undetectable. He presents 5 years later having been “lost to follow up.” He complains of pain in his hip and lower back. His PSA level is now markedly elevated.  

1. What initial investigations are warranted?  
2. What therapies are available for this complication?

I would appreciate any help with this question! Thanks!!

Answer 1

Hi Alesha, his now markedly elevated PSA suggests recurrence or spread of his prostate cancer. Prostate cancer has a tendency to spread to the spine and bones through venous plexuses (Batson plexus).

a. The patient will likely need a MRI to detect spinal and bony metastases.

b. The patient will need systemic therapy to reduce his symptoms and slow down progression of his cancer. This can include chemotherapy or radiation.