Metastatic prostate cancer (with prostate-specific antigen of 9996) presenting as obstructive jaundice

A 78-year-old man admitted with clinical jaundice and pelvic pain had a tot al bilirubin level of 6.56 mg/dL, an alkaline phosphatase level of 855 U/L, and a prostate specific antigen (PSA) level of 9996 ng/mL. A computed tomo gram demonstrated marked retroperitoneal, peripancreatic, periceliac, and p eriaortic lymphadenopathy. A bone scan revealed increased radiolabeled tech netium uptake in the pelvis, vertebral column, parietooccipital region, rib s, and appendiceal skeleton. A biopsy of one pelvic lesion revealed metasta tic prostate cancer. This man's obstructive jaundice and bone pain had a dr amatic response to treatment with a gonadotropin-releasing hormone analog ( leuprolide) and antiandrogen (bicalutamide). All bone pain and clinical sig ns of jaundice disappeared in 1 week. His total bilirubin decreased to 0.84 mg/dL by 2 weeks. His PSA values reflected this clinical response, decreas ing to 4022 ng/mL in 1 week, 2680 ng/dL after 2 weeks, and 1028 ng/mL after 1 month of the above therapy.