Presented here is a 66 year old male who is a known case of prostate adenocarcinoma gleason score 9 (4+5) and who underwent open radical retropubic prostatectomy with bilateral pelvic lymph node dissection, followed by 45 cycles of radiation therapy with continous androgen deprivation therapy. Afer completion of radication therapy, Choline PET CT was done which revealed enlarged paracaval, aortocaval and paraaortic lymph nodes. The patient then underwent exploratory laparotomy, retroperitoneal lymph node dissection which found four out of twenty five lymph nodes removed that were positive for tumor metastases. There was a significant drop in the prostate specific antigen level two months post-surgery, from 7.43 to 1.54. Androgen deprivation therapy was still continued post-operatively.
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