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62-year-old man seen with elevated PSA. Rectal: Moderate enlargement of prostate bilaterally. Lower half of left lobe contains large nodule and has an irregular surface.
Chest: Normal. Bone scan: Moderate increased uptake at L4. Also increased uptake in left ankle and left knee. These areas of increased uptake are consistent with arthritic changes. CT abdomen: Within normal limits.
PSA: 21.8 (normal 4.0) Alk phos: 123 (normal 69 - 241).
Needle biopsy: Poorly differentiated adenocarcinoma.
Prostatectomy: Gross: Left pelvic LNs, right pelvic LNS, prostate and vesicles. Micro: Adenoca prostate gland, Gleason's pattern 3; perineural and seminal vesicle invasion, all margins negative. 0/19 LNs involved
Surgery: Bilateral pelvic lymphadenectomy and radical retropubic prostatectomy.