Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Oct 5;15(10):e251036.
doi: 10.1136/bcr-2022-251036.

Remission of progressive metastatic castration-resistant prostate cancer during abiraterone therapy following unilateral adrenalectomy for a functioning adrenal adenoma

Katelyn Nazaneen Seale  1 , Matthew K Labriola  1   2 , Xiaoyin Sara Jiang  3 , Andrew Armstrong  4   2   5
Affiliations
Case Reports

Remission of progressive metastatic castration-resistant prostate cancer during abiraterone therapy following unilateral adrenalectomy for a functioning adrenal adenoma

Katelyn Nazaneen Seale et al. BMJ Case Rep. .

Abstract

Despite advances and introduction of new therapies in the last decade, metastatic castration-resistant prostate cancer (mCRPC) has a poor prognosis. The development of androgen axis-targeted therapies such as abiraterone acetate, enzalutamide and darolutamide can prolong survival in mCPRC; however, resistance remains a barrier to prolonged response, necessitating exploration into resistance mechanisms and locoregional therapies. Here, we describe a patient with mCRPC that was progressing on abiraterone acetate. He was also found to have primary hyperaldosteronism from a functional adrenal adenoma, and thus he had a partial adrenalectomy to remove this tumour. Pathology confirmed an aldosterone-producing adrenal adenoma. After his adrenalectomy, he had a sharp decline in both his PSA (prostate specific antigen) and testosterone levels, and he enjoyed a year-long period of remission after his adrenalectomy. We propose several explanations for his response, the most likely being that his adenoma was producing both aldosterone and androgens. This is a unique case of mCRPC responding to partial adrenalectomy from a functional adrenal adenoma, and it raises insights that warrant further investigation into underlying mechanisms of resistance to androgen-targeted therapies.

Keywords: Prostate; Prostate Cancer; Urological cancer.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The patient’s blood pressure (in mm Hg) over time in months relative to the date of his adrenalectomy, which is represented by the black star. The green double arrow depicts the time period the patient was on certain blood pressure medications prior to his adrenalectomy, and the gold double arrow represents the time period the patient was on certain blood pressure medications after his adrenalectomy.
Figure 2
Figure 2
(A) Low-power view of adenoma demonstrating a mix of eosinophilic cells and cells with cytoplasmic lipid (H&E, 100×). (B) High-power view of adenoma demonstrating lipid-rich cells with characteristic spironolactone bodies; intracytoplasmic eosinophilic inclusions with concentric laminations (arrowheads) (H&E, 400×).
Figure 3
Figure 3
The patient’s serum total PSA (ng/mL) over time in months relative to the date of his adrenalectomy, which is represented by the black star. The coloured double arrows represent the duration of time that the patient was on certain therapies for his prostate cancer.
Figure 4
Figure 4
The patient’s total testosterone level (ng/dL) over time in months relative to the date of his adrenalectomy, which is represented by the black star. The coloured double arrows represent the duration of time that the patient was on certain therapies for his prostate cancer.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Moreira DM, Howard LE, Sourbeer KN, et al. . Predicting time from metastasis to overall survival in castration-resistant prostate cancer: results from search. Clin Genitourin Cancer 2017;15:60–6. 10.1016/j.clgc.2016.08.018 - DOI - PMC - PubMed
    1. Armstrong AJ, Lin P, Tombal B, et al. . Five-year survival prediction and safety outcomes with enzalutamide in men with Chemotherapy-naïve metastatic castration-resistant prostate cancer from the prevail trial. Eur Urol 2020;78:347–57. 10.1016/j.eururo.2020.04.061 - DOI - PubMed
    1. Annala M, Taavitsainen S, Khalaf DJ, et al. . Evolution of castration-resistant prostate cancer in ctDNA during sequential androgen receptor pathway inhibition. Clin Cancer Res 2021;27:4610–23. 10.1158/1078-0432.CCR-21-1625 - DOI - PubMed
    1. Mostaghel EA, Montgomery B, Nelson PS. Castration-resistant prostate cancer: targeting androgen metabolic pathways in recurrent disease. Urol Oncol 2009;27:251–7. 10.1016/j.urolonc.2009.03.016 - DOI - PMC - PubMed
    1. Cai C, Balk SP. Intratumoral androgen biosynthesis in prostate cancer pathogenesis and response to therapy. Endocr Relat Cancer 2011;18:R175–82. 10.1530/ERC-10-0339 - DOI - PMC - PubMed

Publication types