1. 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 1 st rib (there was a history of trauma in this region and MRI did not confirm metastasis) EBRT +ADT was initiated

2. 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

8. PSA=1.5

9. Bone Scan

10. 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?