• Xiaojuan Zhu, Zhenguo Shi, Shegan Gao, Xiaohong Wang, Pei Wang, Chongzhao Kang, Fangzong Zhao, and Peng Hou.
• Department of Radiation Oncology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.
• Medicine (Baltimore). 2021 Apr 16; 100 (15): e25584e25584.

IntroductionPrednisone (10 mg/d) is often used in combination with docetaxel or abiraterone in the treatment of advanced prostate cancer. LATITUDE studies have confirmed that the combination of abiraterone and prednisone (5 mg/d) can be used for the treatment of newly diagnosed high-risk metastatic castration-sensitive prostate cancer, and have achieved satisfactory results. However, it has not been reported that abiraterone combined with prednisone (5 mg/d) in the treatment of metastatic castration-resistant prostate cancer (mCRPC).Patient ConcernsHere, we present a case of high-risk advanced prostate cancer with old pulmonary tuberculosis (PTB). The patient developed a relapse of old tuberculosis in both lungs that were discovered following 14 months of continuous application of prednisone (10 mg/d).DiagnosisThe histopathological findings showed prostate adenocarcinoma carcinoma with a Gleason score of 10 (5+5). Further laboratory investigations were suggestive of positive mycobacterium tuberculosis complex DNA in pleural effusion and sputum.InterventionsThe patient underwent endocrine therapy, chemotherapy of docetaxel plus prednisone, radiotherapy, and abiraterone combined with prednisone treatment, but he eventually developed into the mCRPC stage. Then, prednisone was reduced to 5 mg/d plus abiraterone, and combined with anti-tuberculosis treatment according to multi-disciplinary diagnosis and treatment.OutcomeTwo months later, pleural effusion and atelectasis were relieved, and PSA was remained stable at a low level. The patient achieved complete remission.ConclusionWe cannot, with complete certainty, say that this patient, or any patient, developed old PTB recurrence due to the use of prednisone. Based on the current evidence, endocrine therapy is the foundation, radiotherapy can reduce the tumor load, and early application of abiraterone is beneficial to survival for the high-risk mCRPC. The long-term use of prednisone can be appropriately reduced in mCRPC with old PTB, and a satisfactory curative effect can be achieved. More prospective trials are warranted before a definite recommendation could be drawn.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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