Usual acinar adenocarcinoma and osteoblastic lesion in the distal middle third of the femur, an unusual finding: a case report / Adenocarcinoma acinar usual e lesão osteoblástica no terço médio distal do fêmur, um achado incomum: relato de caso

A patient with prostate cancer may initially be asymptomatic, compromising early diagnosis and treatment. A 42-year-old male patient on a routine examination had a PSA of 4.18 ng / ml. Prostate biopsy revealed usual Gleason 7 stage T2a acinar adenocarcinoma. Magnetic resonance imaging revealed a nodule in the prostate. Bone scintigraphy showed osteoblastic lesion of the left femur, considered a possibility of a secondary lesion to adenocarcinoma, but his biopsy showed tissue without significant histological changes, ruling out malignancy. The patient was submitted to a radical prostatectomy and bilateral lymphadenectomy, evolving without complications. Follow-up tests showed reactive Protein C negative, alkaline phosphatase, lactate dehydrogenase and total testosterone without changes, total PSA 0.011; Free PSA less than 0.01. The total PSA 0.3 indicated a possible recurrence after 3 years. Magnetic resonance imaging showed no suspicious lesions, PET / CT was performed, which showed molecular hyperexpression of specific membrane antigen for the prostate, confirming local recurrence. Therefore, he was submitted to 36 radiotherapy sessions in the prostate bed from July to August. In October, the total PSA was performed, which decreased sharply. The early stage of prostate cancer may show only benign prostate growth, while the advanced stage may reveal bone pain. Bone tissue often develops a metastatic lesion, resulting in a worse prognosis. In this patient, a link between prostate carcinoma and bone lesion was ruled out by biopsy, which demonstrated the absence of spread of the disease.