Prostate Cancer

Metastatic, hormonally-resistant adenocarcinoma of the prostate

A 61 year old man presented with metastatic hormonally-resistant adenocarcinoma of the prostate with extensive skeletal metastases.  He received 12 Immunepheresis procedures targeting soluble cytokine receptors. His bone scan prior to treatment revealed diffuse osteoblastic lesions throughout the appendicular and axial skeleton with the most notable areas of increased uptake in the C2 and C3 vertebrae, in the thoracic spine at T9-T11.  There were also metastases to the left 11^th and 7^th ribs and the 2^nd rib on the right.  There were also metastases in the proximal left humerus, and extensive uptake within the left hemipelvis and uptake in the right hemipelvis.  Prior to treatment his PSA was 140 ng/ml.  With treatment his PSA rose to a maximum of 182 coincident with a fall of alkaline phosphatase from 200 to 171.  Within one month of the 12^th procedure all bone pain resolved and his PSA fell to 47 and his alkaline phosphatase to 110.  Repeat bone scan one month after the last procedure showed a 50-60% reduction of the metastatic foci.

Stage B2 adenocarcinoma of the prostate

A 54 year old man with stage B2 adenocarcinoma of the prostate, Gleason score 3+4.  The patient’s abdominal and pelvic CAT and bone scans were normal. The prostatic ultrasound revealed a 2 cm mass in the prostate gland, confirmed by physical examination.  The mass was hypoechogenic with some indentation on the inferior floor of the bladder.  Prior to treatment his PSA was 15 and his alkaline phosphatase was 66.  After 12 Immunepheresis procedures his physical examination revealed a soft fluctuant area that had replaced the area of tumor.  Repeat biopsy after treatment  revealed extensive coagulative necrosis with giant cell formation and mononuclear cell infiltrate into the large area of necrotic debris.  Multiple biopsies were negative for cancer cells.  His PSA had fallen to 2.9.

Metastatic adenocarcinoma of the prostate

A 58 year old man was found to have an enlarged prostate gland on annual physical examination.  An ultrasound-directed needle biopsy revealed adenocarcinoma in both the left and right prostatic lobes.  The biopsy revealed a Gleason’s grade 2+3 tumor.  CAT scan revealed no abnormal periprostatic masss or lymphadenopathy.  A bone scan revealed increased areas of isotope labeling in the left 6^th and 8^th ribs, proximal shaft of the left humerus, within the neck and the right femur. A prostatic ultrasound revealed a hypoechogenic region near the base of the prostate to the right of the midline. He refused hormonal therapy. His initial laboratory evaluation included a PSA of 13 with an alkaline phosphatase of 101 mg/dl.  In response to filtration he developed low grade fever associated with aching pain in in his ribs bilaterally, his right humerus, and in his pelvis.  By the end of one month of treatment with Immunepheresis his bone pain resolved.  His PSA fell to 3.  Repeat bone scan performed six months after treatment showed complete clearing of the abnormalities seen on the pre-treatment bone scan. His follow-up physical examination and prostatic ultrasound were normal.