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Case Reports
. 2018 Mar 16:2018:bcr2017223637.
doi: 10.1136/bcr-2017-223637.

Successful treatment of concomitant metastatic prostate cancer and B-cell non-Hodgkin's lymphoma with R-EPOCH chemotherapy regimen and antiandrogen therapy

Fayez Hanna  1 , Ajay Prakash  2   3 , Ebony Allan  3 , Alhossain A Khalafallah  1   3   4   5
Affiliations
Free PMC article
Case Reports

Successful treatment of concomitant metastatic prostate cancer and B-cell non-Hodgkin's lymphoma with R-EPOCH chemotherapy regimen and antiandrogen therapy

Fayez Hanna et al. BMJ Case Rep. .
Free PMC article

Abstract

A 70-year-old man presented with left loin pain without urinary symptoms. Initial investigations with CT showed enlarged para-aortic, mediastinal lymph nodes, right-side renal mass and enlarged prostate. A prostatic-specific antigen (PSA) was alarmingly high at 4750 μg/L (normal <4.0 μg/L). Further investigations included positron emission tomography (PET); both prostate-specific membrane antigen and 18-fluorodeoxyglucose as well as bone scan and bone marrow examination confirmed dual malignancies with B-cell non-Hodgkin's lymphoma (B-NHL) and wide spread metastatic prostatic adenocarcinoma (PA) to the skull, spine, pelvis, liver and lungs. The patient was treated with six cycles of rituximab, etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin(R-EPOCH) containing regimen for B-NHL and goserelin hormonal therapy for PA. Restaging with PET scans thereafter showed complete remission of NHL with disappearance of his metastatic PA and normalisation of PSA levels. R-EPOCH regimen and antiandrogen therapy resulted in a good outcome and remission of both malignancies.

Keywords: malignant and benign haematology; malignant disease and immunosuppression; prostate cancer.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Prostate-specific membrane antigen PET scan for prostate cancer. Arrows indicate the site of bone metastasis on the hip bones before chemotherapy (left panel) compared with after chemotherapy (right panel). PET, positron emission tomography.
Figure 2
Figure 2
18-fluorodeoxyglucose PET scan for non-Hodgkin’s’ lymphoma. Arrow indicates the site of lymphoma uptake in the right renal area before chemotherapy (left panel) compared with after chemotherapy (right panel). PET, positron emission tomography.
Figure 3
Figure 3
H&E stain of the bone marrow trephine showing marrow infiltration with non-haematopoietic malignant cells (arrow).
Figure 4
Figure 4
H&E stain of the bone marrow trephine showing well-circumscribed marrow infiltration with non-haematopoietic malignant cells (low magnification).
See this image and copyright information in PMC

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