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Sandy Srinivas, MD


Prostate Cancer, Multiple Myeloma, and CML: A Rare Triple Combination in a Single Patient

By: Joshua D. Madera, MS
Posted: Monday, April 10, 2023

Amirhosein Maharati, MD, of Mashhad University of Medical Sciences, Iran, and colleagues reported the first documented case of a triple combination of primary cancers, including prostate cancer, multiple myeloma, and chronic myeloid leukemia (CML) in the Journal of Medical Case Reports. The authors suggest always considering the possibility of multiple primary cancers when treating patients and during follow-up visits so that appropriate measures can be taken immediately.

The patient was an 85-year-old man who presented with urinary frequency, hesitancy, and dysuria. He had elevated urea, creatinine, and prostate-specific antigen levels indicative of prostate carcinoma. An MRI revealed a normal-sized prostate gland; however, there was evidence of peripheral zone lesions, which supported the initial suggestion of prostate cancer. His calculated prostate imaging reporting and data system score was 5, which is suspicious for prostate carcinoma. The standard protocol required a direct biopsy for further analysis, which revealed unilateral adenocarcinoma with a Gleason score of 8. Furthermore, his biopsy samples showed invasion of the surrounding tissues, a desmoplastic reaction in five tissue samples, and malignant neoplastic proliferation of epithelial cells. These collective findings confirmed his diagnosis of prostate cancer. Furthermore, the patient underwent a whole-body scan, and a bony lesion within the middle portion of the left femur was identified. The patient was subsequently started on hormone replacement therapy.

Less than 1 year later, the patient returned with complaints of left-upper quadrant pain, fatigue, and weight loss. Further serum analysis was suggestive of CML, which was later confirmed with a positive BCR/ABL P210 fusion gene on real-time polymerase chain reaction. About 5 years later, he was diagnosed with multiple myeloma and died despite treatment.

Disclosure: The study authors reported no conflicts of interest.

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