On 17 December 2007, a 46-year-old female underwent a radical left mastectomy; post-operative histology showed an infiltrating ductal carcinoma with microscopic lesions of ductal carcinoma in situ.\npT2 N3a (14/28) M1 was the post-operative TNM classification, G3, ER+ (90%) Pr+ (90%), Ki67 40%, and HER2 negative. The post-operative work-up, BS and WB CT showed two metastatic lesions involving the left iliac crest and pubic symphysis, respectively, with elevated serum TPA values. From 9 January 2008 to 31 July 2008, she received salvage chemotherapy with six cycles of 5-fluorouracil-epirubicin-cyclophosphamide (FEC) (600/60/600 mg/sqm on days 1 and 28) followed by four cycles of docetaxel (80 mg/sqm every 21 days). From 1 August 2008 to 2 March 2009, she was continuously given 1 mg anastrozole pills (one pill/day). On 2 March 2009, she was recruited for a pilot study, which we have more times reported [,,,], that applied cycles of IT with beta- interferon and interleukin-2 in addition to continuous conventional salvage hormone-therapy. From April to June 2010, clinical examination, bone scanning, and subsequent abdominal CT showed a complete clinical radiological response with normal values of the serum CEA-TPA-CA15.3 tumor marker panel. To date, these normal values have been maintained during intensive post-operative monitoring. In 2015 and 2016, IT cycles were interrupted for four months; in 2017, 2018, and 2019, both IT and concomitant hormone-therapy were interrupted for 7, 6, and 6 months, respectively.\nOccasionally, metastatic breast cancer patients have been reported with more than a 10-year CR following conventional therapy []. However, these studies had relatively poor clinical-radiological documentation [,].
On 22 April 2010, a 65-year-old male underwent RP and vesiculectomy for prostate adeno-carcinoma. The pre-operative serum PSA was 13.66 ng/mL. pT3b No Mo was the post-operative TNM classification, G3, 4 + 4 Gleason, stage III. On 7 July 2010, the serum PSA was 0.01 ng/mL. On 10 April 2013, three months after RP, BCR was found to have occurred with two consecutive serum PSA values higher than 0.2 ng/mL (PSA level of 0.23 ng/mL). From 22 April 2013 to 10 May 2015, he received IAD therapy with 150 mg bicalutamide pills (once a day) and, on 9 February 2015, the serum PSA level was 0.02 ng/mL. From 11 May 2015 to 1 November 2015, no adjuvant therapy was given and, on 6 October 2015, the serum PSA level was 0.27 ng/mL. From 2 November 2015 to 29 October 2017, cyclic IT was administered. On 5 October 2017, the serum PSA level was 0.65 ng/mL. From 30 October 2017 to 13 May 2018, he received only 150 mg bicalutamide pills (once a day) and, on 9 May 18, the serum PSA level was 0.24 ng/mL. After that, as a result of a misunderstanding, the patient delayed the beginning of cyclic IT from 14 May 2018 to 11 June 2018. Moreover, during the first cycle of this new round of cyclic IT (from 11 June 2018 to 7 July 2018), he took one instead of four celecoxib pills a day. On 11 July 2018, the serum PSA level was 0.58 ng/mL. From 22 July 2018, he correctly underwent IT cycles and, on 11 May 19, the serum PSA was 0.99 ng/mL. He started on 50 mg bicalutamide pills (once a day), and an LHRH agonist was given subcutaneously once every three months. On 10 August 19, PSA was undetectable; therefore, he again started the IT schedule. On 10 October 19, the last PSA determination was 0.04 ng/mL.\nIn a study [], researchers examined 148 patients who prospectively enrolled in sequential Institutional Review Board approved vaccine protocols. The T stage was T1–T2 in 54% and T3–T4 in the remaining 46%; Gleason was 6–7 in 71% and 8–9 in the remaining 29%. All subjects had recurrent disease and no detectable radiological metastases. Recurrent disease manifested as BCR after surgery or as clinically localized disease at the sites for which they had undergone radiation therapy. The median PSA value at the time of protocol enrollment was 8.2 ng/mL and the median PSA double time (PSADT) was 4.7 months. Overall, 110 (74%) of the 148 patients showed metastatic progression at a median of 19 months and metastases were detected in 68% and 84% of them at 3 and 5 years, respectively. Patients with a T3 stage and Gleason score of 7 or more at the time of diagnosis were more likely to develop metastatic disease (log-rank test; p = 0.006), while the type of primary therapy and the presence of nodal disease were not predictive. In another study [], the researchers analyzed 1590 patients who developed recurrent disease, among 5277 patients who had undergone either RP (1003 patients) or EBRT (587 subjects). In the RP group, about 13% of the 1003 patients had received neo-adjuvant or adjuvant androgen deprivation therapy (ADT) and the mean time between primary treatment and recurrence was 34 months. PSA data after salvage therapy were available for 1050 patients (430 patients who had received initial EBRT and 620 patients from the RP group). In 367 patients (59.2%) in the RP group, ADT was the most common salvage treatment, followed by EBRT, which was carried out in the other 248 patients (40%). ADT was also administered to 402 subjects (93.5%) in the EBRT group. Failure after salvage therapy was defined as a PSA level of >0.2 ng/mL after treatment. Overall, 420 (68%) of the 620 patients in the RP group and 319 (74%) of the 430 patients in the EBRT group recurred after salvage therapy. Among these, 739 patients (24.8%) died. The mean survival was 81.1 months (median of 59.9 months) compared with 103.2 months (median of 101.2 months) for those who did not recur after salvage therapy. This difference in overall survival was statistically significant (p < 0.001). A report of a phase III randomized trial [] presented the long-term results of immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer. In a subgroup of 127 high-risk patients, eight-year clinical disease-free survival (DFS) was about 40%. The high-risk category was defined as having at least two of the following three risk factors: WHO performance status > 0, G3, and initial PSA > 10. Our patient, who shares these characteristics, is alive and in good health 114 months after RP.