Abstract

Patient male 65 years old (2017), submitted in July 2009 to prostatic radiotherapy without hormonal blockade due to prostate adenocarcinoma Gleason 6 (3+3) with total initial PSA of 43.67 and bone scintigraphy (2009) not identifying metastatic disease. At follow-up, it maintained high total PSA (16.25 in December 2014). Recurrence tests (MRI, bone scintigraphy, and total PSA) excluded lymph node and metastatic disease, but with increasing total PSA. The patient was submitted to prostate biopsy identifying a prostate adenocarcinoma Gleason 7 (4+3) and surgical salvage treatment was indicated. In July 2016, he underwent radical salvage prostatectomy with extended pelvic lymphadenectomy and was diagnosed a prostate adenocarcinoma Gleason 9 (4+5), involving both prostatic lobes with a right border, focally compromised by neoplasia, bladder border with atypical cells, neoplasia-free urethral limit, seminal vesicles and deferent neoplasia-free, neoplastic-free pelvic lymph nodes with pathological staging: pT2c pN0. Postoperative follow-up (7 months after surgery) maintained an undetectable total PSA (<0.09), continent and with erection in use of phosphodiesterase type 5 inhibitors.

Keywords: Radical salvage prostatectomy; Pelvic lymphadenectomy; Prostatic radiation therapy