1. Case Presentation HKC 1392

2. A 78 y/o man obstructive symptoms Flank pain(_) Gross hematuria(-). LUTS(+)

3. Past history Open prostatectomy 1389/4/27 in Rasoul Akram Hosp. Negative for malignancy

4. Physical examination Normal DRE:+ 1> /Firm/symmetric/without nodule

5. Lab data: 1389/8 Cr:1.2 PSA: 41

6. TRUS GUIDED BIOPSY: 1389/9/27 Adenocarsinom of prostate Rt&Lt base : 4+4, 4+3 (80%, 40%) Rt&Lt upper- mid : 3+4, 3+4 (90%, 70%) Rt&Lt lower- mid : 4+4, 4+4 (80%, 70%) Rt apex : 4+3 ( 50%) Lt apex: benign proststic tissue PNI (+) Extra prostate (-)

7. Bone scan Multiple bone metastases

9. Medical therapy DIPHERELIN therapy since 1389/8 monthly & FLUTAMIDE since 1391/10

11. Thanks for Attention