Clinically, Radiologically and Biochemically Metastatic Cancer Prostate: Could be Treated without Biopsy? A Clinical Case Study and Review of Literature

Diagnosis of prostate cancer is suspected if there are abnormalities during digital rectal examination (DRE) and/or steady rising in levels of prostate specific antigen (PSA) and the confirmative diagnosis is established by histopathological confirmation of malignancy by biopsy from the prostate. A 87 years old male not diabetic nor hypertensive or other co-morbidities was well apart from mild lower back pain associated with mild irritative urinary symptoms, diagnosed clinically (DRE), radiologically and biochemically (markedly elevated PSA level) as a case of advanced prostate cancer and started treatment without biopsy by androgen deprivation therapy with other symptomatic support. After one month of treatment and then after, general conditions of the patient started to be significantly improved, the first follow-up CT showed considerable decrease of the mass size, then total non visualization of the previous prostatic mass, with marked decrease of the lymph nodal size in subsequent follow-up, PSA level decreased markedly, dropped from ≥700 ng/mL to 6.867 ng/mL, and then continued to decrease in subsequent monthly evaluations to reach 0.212 ng/mL at the last measurement after 8 months of treatment, that mean near complete radiologic and biochemical response. Treatment of advanced prostate cancer might be started without biopsy if there is high probabilities malignancy by DRE, imaging studies and significant rising in PSA levelin exceptional cases.