Yadav Ruchi, Huang Shengmin, Uche Ifeanyi, Pokhrel Akriti, Zahid Umar, Mooppan Unni, Wang Jen Chin
Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA.
Department of Medicine, Brookdale University Hospital Medical Center, Brooklyn, NY, USA.
Am J Case Rep. 2025 Mar 28;26:e946869. doi: 10.12659/AJCR.946869.
BACKGROUND Prostate cancer (PCa) tends to spread most often to the regional lymph nodes and then to the skeleton. The prevalence of bone metastases is more than 80% in patients with metastatic PCa. Non-regional lymph node (NRLN) metastasis is defined as cancer cells spreading to lymph nodes distant from the primary tumor and often signals a more advanced stage of cancer. We are reporting such a rare case of NRLN without skeletal metastasis in PCa. CASE REPORT We report a rare case of persistently elevated PSA >20 ng/mL after the treatment of localized PCa in the past. A workup by PSA positron emission tomography (PSMA-PET) scan showed the presence of bulky retroperitoneal massive lymphadenopathy, a type of NRLN metastasis, in the absence of bone metastasis. The patient was then treated with abiraterone plus docetaxel, leading to a decrease in PSA levels from 21 ng/mL to 2.42 ng/mL. The PSMA-PET scan also showed significant shrinkage of lymphadenopathy, marking a favorable response. CONCLUSIONS Castration-resistant PCa typically metastasizes to bone, but our case presents a rare occurrence of bulky NRLN metastasis without skeletal involvement. The use of PSMA-PET imaging and genetic testing can help identify this atypical metastatic pattern. Early recognition is crucial, as it enables more accurate diagnosis and prompt treatment decisions and improves outcomes through timely intervention and personalized therapeutic strategies.
背景 前列腺癌（PCa）最常转移至区域淋巴结，然后转移至骨骼。转移性PCa患者骨转移的发生率超过80%。非区域淋巴结（NRLN）转移定义为癌细胞扩散至远离原发肿瘤的淋巴结，通常预示癌症处于更晚期阶段。我们报告了1例罕见的PCa患者出现NRLN转移但无骨骼转移的病例。病例报告 我们报告1例既往局限性PCa治疗后前列腺特异性抗原（PSA）持续升高>20 ng/mL的罕见病例。经PSA正电子发射断层扫描（PSMA-PET）检查发现存在巨大的腹膜后大量淋巴结肿大，这是一种NRLN转移类型，且无骨转移。该患者随后接受阿比特龙联合多西他赛治疗，PSA水平从21 ng/mL降至2.42 ng/mL。PSMA-PET扫描还显示淋巴结肿大明显缩小，表明治疗反应良好。结论 去势抵抗性PCa通常转移至骨骼，但我们的病例呈现出罕见的巨大NRLN转移而无骨骼受累的情况。使用PSMA-PET成像和基因检测有助于识别这种非典型转移模式。早期识别至关重要，因为它能实现更准确的诊断和及时的治疗决策，并通过及时干预和个性化治疗策略改善治疗效果。
