• A 74 year old man underwent open prostatectomy due to moderate to severe urinary symptoms unresponsive to medical therapy.

• Preoperative PSA was 4.1

• Postoperatively a retrovesical mass was found in CT scan

• CT guided biopsy revealed prostate adenocarcinoma (Gleason 4+5)

• Bone scan showed abnormal uptake in 1st rib (there was a history of trauma in this region and MRI did not confirm metastasis)

• EBRT +ADT was initiated

• ADT lasted for 6 months

• PSA remained below 1 during the course of treatment

• One year after completion of treatment he is presented with shoulder pain

• MRI & CT showed large soft tissue mass at the apex of right lung

PSA=1.5

Bone Scan

• Is this pattern usual for PCa?

• Is biopsy necessary to confirm metastasis from prostate?

• Is there any role for Docetaxel chemotherapy in this patient?

• Is there any role for radiation therapy in this patient?