Jung Seongeun, Hong Seong Sook, Bae Sung Hwan, Hwang Jiyoung, Lee Eun Ji, Kim Kyeongmin, Jeong Sun Young
J Korean Soc Radiol. 2025 May;86(3):407-412. doi: 10.3348/jksr.2024.0006. Epub 2025 Apr 29.
Prostate specific antigen (PSA) is a crucial tool for detecting and monitoring of prostate cancer, and elevated levels of PSA often indicate disease progression. Higher PSA levels are generally associated with more aggressive cancers and an increased risk of cancer-specific mortality. In this report, we present an unusual case of primary aggressive prostate cancer characterized by unexpectedly low PSA levels, despite the presence of multiple lumbar bone metastases at the time of diagnosis. It is extremely uncommon to have a low PSA level at the time of initial prostate cancer diagnosis, especially in cases that are non-recurrent, and even more so for adenocarcinomas without neuroendocrine differentiation. This report highlights the challenges in accurately diagnosing disease using CT and MRI findings when confronted with atypically low PSA patterns, necessitating invasive diagnostic approaches such as transperineal biopsy following abdominoperineal resection in a patient with a colostomy.
前列腺特异性抗原（PSA）是检测和监测前列腺癌的关键工具，PSA水平升高通常表明疾病进展。较高的PSA水平通常与侵袭性更强的癌症以及癌症特异性死亡风险增加相关。在本报告中，我们呈现了一例原发性侵袭性前列腺癌的罕见病例，其特征是尽管在诊断时存在多处腰椎骨转移，但PSA水平却出人意料地低。在前列腺癌初诊时PSA水平低极为罕见，尤其是在非复发性病例中，对于无神经内分泌分化的腺癌更是如此。本报告强调了在面对非典型低PSA模式时，利用CT和MRI检查结果准确诊断疾病所面临的挑战，这就需要采取侵入性诊断方法，如对一名有结肠造口术的患者在腹会阴切除术后进行经会阴活检。
