Serum Elevation of CEA and CA 19-9 in an Aggressive Variant of Prostatic Carcinoma

Abstract

Although prostate cancer is the most common cancer in male patients, it is only the second leading cause of cancer death in men because of the often slow course of the disease (1). Some environmental and genetic promoting factors have been described, including older age, increased duration of androgen exposition, black race and a high-fat low-ber diet (2). Prostate speci c antigen (PSA) levels and histopathological grading are currently used as prognostic factors, with a proven correlation between PSA level and tumor volume and stage (3). Tumor size, ploidy and amount of angiogenesis can also be prognostically important (4).A rare case is reported of a patient with locally advanced hormone refractory metastatic adenocarcinoma of the prostate who had normal PSA but excessive serum levels of CEA and CA 19-9 along with unusual sites of metastases and who responded very well to chemotherapy with mitomycin C.Case report. The patient, a 58-year-old, had a short history of pelvic pain when diagnosed with carcinoma of the prostate by ultrasound-guided biopsy in spring of 1998. Histology revealed an undifferentiated adenocarcinoma of the prostate (Gleason score 9, clinical stage T3b). Additional immunostaining of the biopsy was positive for PSA and prostatic acid phosphatase in several tumor cells. CEA and CA 19-9 immunostains, which were done retrospectively, remained negative. Serum PSA was not elevated at the time of diagnosis. (value: 0.29 mg l).Hormone ablative therapy with utamide and an LHRH-analogue was started. After 3 months, CT and MRI scans were performed for restaging revealing massive progression of the disease with in ltration of the bladder, right seminal vesicle and rectum. In addition, extensive liver metastases with the beginning of compression of the portal vein were diagnosed ( Fig. 1 -left). A bone scan revealed metastatic lesions in the vertebral bone and hips. The patient was referred to our department for radiotherapy, complaining of progressive bowel obstruction symptoms, weight loss and pelvic pain, as well as abdominal tension and pain in the right upper quadrant.Baseline laboratory tests again revealed a normal PSA level (2.1 m g l ( -normal range: B 4 mg l)) but surprisingly elevated levels of CA 19.9 (80 kU l; ( -normal range B37 kU l)) and CEA (204 m g l; ( -normal range B5 m g l)). As the patient presented with rectal obstruction and showed elevated tumor markers for colorectal cancer with hepatic metastases, we suspected a second malignancy and thus decided to re-evaluate the diagnosis.A rectosigmoidoscopy and endoscopy of the colon descendens was performed, showing an intact rectal mucosa compressed by external tumor. An abdominal CT scan gave no evidence of another primary site (e.g. pancreatic cancer). A liver biopsy was arranged and revealed in ltration of a solid carcinoma (e.g. undifferentiated adenocarcinoma), expressing pancytokeratin, and prostate acid phosphatase.PSA was negative in this specimen. Because of an identical histology of the prostatic and liver tumor cells and the e...

Multiple osteolytic bone and lung metastases from prostate cancer including small cell carcinoma with marked increases in CEA and Pro-GRP

“…Generally, elevated CEA is seen in carcinoma, especially those in the gastrointestinal tract, but there were no tumors in the related organs. Two previous case reports on small cell carcinoma of the prostate described elevated CEA, 1 , 2 but there are no reports of four-digit CEA levels, as recorded in the present case, outside of gastrointestinal carcinoma. Pro-GRP is known to increase in small cell lung cancer.…”

“…PSA is a well-known tumor marker for prostate cancer. CEA is mainly elevated in gastrointestinal carcinoma, but some case reports have described increases in prostate cancer 1 , 2 . Pro-GRP is used as a tumor marker for small cell carcinoma.…”

Elevation of the tumour marker CA19-9 in a pancreatic cancer survivor with benign prostatic hyperplasia: A clinical case report

“…Although not common, elevated serum CA19-9 and increased CA19-9 tissue expression has been observed in patients with prostate cancer in several case reports [14][15][16][17][18][19] , but these were mostly in rare prostate cancer subtypes and cases with aggressive metastatic disease. Another case report demonstrated an association between high serum CA19-9 levels (145.8 U/mL) and presence of a benign cystic tumor of the seminal vesicle, of which the fluid from the cyst itself had a notably high CA19-9 reading of 4,864 U/mL 20 .…”

Elevation of the tumor marker CA19‐9 in a pancreatic cancer survivor with benign prostatic hyperplasia: A clinical case report

“…11 However, CA19-9 is not normally expressed in the prostate glandular tissue, and only low levels of expression can be found in the seminal vesicle glandular cells. 13 Although not common, elevated serum CA19-9 and increased CA19-9 tissue expression have been observed in patients with prostate cancer in several case reports, [14][15][16][17][18][19] but these were mostly in rare prostate cancer subtypes and cases with aggressive metastatic disease. Another case report demonstrated an association between high serum CA19-9 levels (145.8 U/mL) and presence of a benign cystic tumor of the seminal vesicle, of which the fluid from the cyst itself had a notably high CA19-9 reading of 4864 U/mL.…”