Metastatic carcinoma of prostate with low PSA and Gleason score

Prostate cancer remains the most common malignancy among men and second leading cause of cancer related mortality. American cancer society recommends screening of all men more than 50 years of age and men with their first degree relative who had prostate cancer to undergo screening starting from 40 years of age. Screening involves estimation of prostatic specific antigen and digital rectal examination. Almost all patients with metastatic prostate cancer present with raised prostate specific antigen. Gleason score is also another factor which accounts for mortality. high scores are associated with more advanced disease. We report a case where patient presented with metastatic prostatic carcinoma with PSA level in grey zone and low Gleason score.