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Adenocarcinoma of the prostate immunostained for carbohydrate antigen 125 and carcinoembryonic antigen

A 78-year-old man with a serum PSA level of 4.9 ng/mL was diagnosed as having prostate cancer (A2, acinar adenocarcinoma of conventional type with features of prostatic duct adenocarcinoma) after TURP. The patient received total androgen blockade therapy and his serum PSA decreased to undetectable levels after 3 months. However, he complained of dysuria and endoscopy showed urethral involvement of the tumour, which pathologically was an anaplastic carcinoma positive for carbohydrate antigen 125 (CA125; Fig. 1a) and focally positive for carcinoembryonic antigen (CEA; Fig. 1b) but negative for PSA. A review of the initial TURP specimens showed that most of the tissues were positive for PSA (Fig. 2) with a few cells stained with CA125 and CEA. Despite an undetectable level of PSA, the serum level of CEA rapidly increased to 175.8 ng/mL, and the patient died with multiple liver and lymph node metastases at 8 months after TURP.