American Oncology Institute (AOI) at Citizens Specialty Hospital, Hyderabad, has successfully managed a complex and rare case of advanced-stage prostate cancer with transformation in a 72-year-old male patient with multiple comorbidities, including diabetes and hypertension. Despite a prolonged medical history marked by recurrent urinary retention and infection and an initial diagnosis of prostate cancer followed by transformation, the patient is now stable and healthy following comprehensive and targeted treatment.

The patient first experienced acute urinary retention several years ago and sought initial care at AOI Hyderabad, where he was diagnosed with Intermediate risk prostate cancer and received Radiotherapy and hormonal treatment. His disease progressed eventually, and he was treated with multiple chemotherapy regimens at another hospital.

When the patient returned to AOI Hyderabad, Dr. Krishnamani KV., Senior Consultant medical Oncology, recommended a re-biopsy. "The patient was initially treated at our hospital but later received multiple lines of chemotherapy elsewhere. When he returned to us, we suggested a re-biopsy, in view of low PSA but progressive disease on scan, which led to the identification of the underlying issue and allowed us to proceed with the appropriate treatment. In patients of CA prostate, who progress but have low PSA, transformation has to be ruled out. Biopsy was done which was suggestive of transitional carcinoma. NGS was sent on tumor which was MSI high & TMB high." explained Dr. Krishnamani KV.

NGS is Next Generation Sequencing, it helps to analyse the tumor for actionable mutations. Patients with rare tumors, those who are heavily pretreated or those with limited treatment options are ideal candidates.

MSI High & TMB High in this patient made him eligible for immunotherapy. He then received immunotherapy with remarkable clinical improvement and continuous to be disease free after 3 years.

This decisive step proved to be the key to unlocking the correct diagnosis. The re-biopsy revealed critical insights into the patient's condition, enabling the team to develop a multidisciplinary treatment plan. Following this precision-led approach, the patient showed significant improvement and has now achieved a stable condition. Very few such cases have been reported in medical literature.

"Managing this case was a challenge, considering the patient’s age, medical history, and the advanced nature of the cancer. Through a well-coordinated approach involving NGS and immunotherapy, we were able to control the disease and enhance the patient’s quality of life," said Dr. K. V. Krishnamani, Medical Oncologist, AOI, Hyderabad.

Prostate cancer remains one of the most common cancers among men globally. According to the World Health Organization, over 1.4 million new cases of prostate cancer are diagnosed each year. In India, it is the second most common cancer among men in urban areas, with cases steadily rising due to increased life expectancy, awareness and frequent PSA testing.

"This case reflects AOI’s commitment to personalized cancer care. Our multidisciplinary teams ensure that each treatment plan is tailored to the individual’s medical history, lifestyle, and cancer biology. We are proud to offer globally aligned cancer care right here in Hyderabad," said Dr. Prabhakar P., Regional Chief Operating Officer, American Oncology Institute at Citizens Specialty Hospital.

At AOI Hyderabad, a team of expert oncologists and specialists integrates cutting-edge technology with personalized care, ensuring the best possible outcomes for patients facing complex cancer diagnoses. AOI remains committed to delivering world-class cancer care, grounded in clinical excellence and patient-centric values.