Metastatic prostate carcinoma to the orbit as the first presentation of disease.

Prostate carcinoma is a common tumor of the older adult male. It is associated with bony metastases, particularly to the axial skeleton. We present two case histories; in both cases, the patients had no prior history of prostate carcinoma. Both cases were diagnosed with CT imaging, elevated PSA, and biopsy. Additionally, they were treated with surgical resection and hormone modulation therapy. While bony metastases are frequently associated with advanced disease, they can also be a cause of presenting symptoms. The CT imaging in these two cases showed the classic hyperostotic findings of prostate cancer. Prostate cancer may cause osteoblastic lesions in contrast to other metastatic bone lesions, which cause destructive osteolytic lesions. During excisional surgery, the tumor was inspected and many stalactite-like lesions were present on the gross sample. We present these and compare them to the CT imaging.

A Unique Case of Prostate Carcinoma Presenting as Retroperitoneal Lymphadenopathy With Normal Levels of Prostate-Specific Antigen and a Prostate of Normal Size: A Case Report.

Despite the significant advancements in prostate-specific antigen (PSA) screening and the diverse array of available treatments, prostate cancer (PCa) still significantly contributes to cancer-related illness. The most prevalent sites for metastases are bones, distant lymph nodes, and abdominal organs. Nevertheless, metastasis to the renal and retroperitoneal regions originating from prostate cancer constitutes an exceptionally uncommon clinical occurrence. Metastatic PCa commonly presents with elevated serum PSA levels, a hallmark of its diagnostic profile. However, there are instances where patients exhibit atypical metastatic patterns or maintain normal PSA levels. In the case under consideration, the patient exhibited a periureteral tumor with an indeterminate primary origin, subsequently confirmed to be metastatic prostate cancer. This case underscores the importance of recognizing the varied and sometimes elusive presentations of metastatic PCa. Despite its rarity, the occurrence of renal and retroperitoneal metastasis emphasizes the need for vigilance and a comprehensive understanding of the diverse manifestations of advanced PCa for timely and accurate diagnosis, which is paramount in optimizing patient care and outcomes.

Superscan on 68Ga PSMA PET/CT in patients with metastatic prostate carcinoma: A case series.

Prostate cancer is the second most common malignancy in men worldwide, with a good prognosis when is detected and treated in early stages, but, when it presents progression to castration-resistant metastatic prostate cancer, most of the cases will have bone metastasis, decreasing the quality of life and life expectancy. For the evaluation of the disease in the routinary clinical practice, 68Ga-PSMA PET/CT, among others is a valuable tool for the evaluation of the disease extension. 68Ga-PSMA PET/CT detects the presence of PSMA receptor in the tumoral tissue, but also has physiologic uptake in certain organs, such as liver, spleen, intestine, kidneys, lacrimal and salivary glands. Total or partial absence of uptake in those organs is rare and may be due to a high metastatic tumor burden, a phenomenon originally described in bone scintigraphy as super scan. We describe a case series of seven patients with prostate cancer from the National Institute of Cancerology in Colombia, in which a super scan pattern was found in the evaluation with 68Ga-PSMA PET/CT, proposing the suppression of uptake in the intestine, liver, spleen, lacrimal and salivary glands as the main criteria for its definition, and showing that renal uptake persists in most cases, considering that, unlike the super scan in conventional bone scintigraphy, this is not a criterion necessary for its definition in the study with 68Ga-PSMA.

A Case Report of a Patient With Prostate Adenocarcinoma Metastatic to the Posterior Peritoneum Despite the Negative Preoperative Prostate-Specific Membrane Antigen (PSMA) Positron Emission Tomography/Computed Tomography (PET/CT) Scan.

Despite the role of prostate-specific antigen (PSA) screening and the multitude of therapies available, prostate cancer (PCa) remains a leading cause of cancer-related morbidity and mortality. For many patients diagnosed with PCa, clinical and radiographic staging are critical components for management decisions. PCa staging with the use of imaging modalities such as MRI and bone scintigraphy is recommended in patients with newly diagnosed intermediate or high-risk PCa and in patients with biochemical recurrence; it is also recommended for monitoring the patient's response to treatment for diagnosed PCa. Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT), recently approved in 2021, is an imaging modality that has been shown to have a greater sensitivity, specificity, and negative likelihood ratio than conventional imaging modalities such as CT, bone scintigraphy, and MRI in prostate cancer staging. Despite the improvement in staging that PSMA-PET/CT can provide, our current report details a false-negative result in detecting a rare PCa metastasis to the peritoneum, which was found at the time of an attempted radical prostatectomy. Although the patient had a negative preoperative PSMA-PET/CT and was presumed to be non-metastatic, the prostatectomy was aborted because the patient was unexpectedly found to have peritoneal metastasis.

An Interesting Case of Prostate Cancer Presenting With Colonic Metastasis.

Prostate cancer is common cancer that grows slowly and tends to metastasize to bones, lungs, and the liver. Most malignancies have established patterns in presentation, localization, and organs where they metastasize. We are presenting a case of a 60-year-old man who presented with abdominal pain and, on further investigation, was found to have polyps in the colon, a flat rectal mass with eccentric thickening of the rectum, a moderately enlarged prostate, and multiple liver masses suggestive of metastasis. It was initially thought to be colorectal cancer with metastasis but was eventually diagnosed as a stage IV prostate adenocarcinoma with metastases to the liver and rectum. It is very unusual for prostate cancer to present with distal metastasis to the liver and rectum, as in this case.

Managing a Rare Case of Mixed Extrapulmonary Small Cell Carcinoma and Adenocarcinoma of the Prostate.

This report presents a remarkable and unusual case of extrapulmonary small cell carcinoma (EPSCC) occurring in the prostate of a 77-year-old male patient with a previous history of prostate adenocarcinoma and multiple metastases. EPSCC is a highly aggressive form of cancer that often results in unfavorable survival outcomes, posing significant challenges in terms of management due to the absence of established treatment protocols. Despite receiving standard treatment including bicalutamide and leuprorelin, the patient's condition showed no improvement. Consequently, the medical team made the decision to administer a carboplatin-etoposide chemotherapy regimen along with durvalumab, drawing upon the efficacy observed in similar treatment approaches for small cell carcinoma of the lung. This case highlights the critical need for further research and clinical trials to establish optimal treatment strategies for EPSCC affecting the prostate. By enhancing our understanding of this rare malignancy, we can potentially improve patient outcomes and develop targeted therapies tailored to its aggressive nature.

An Unusual Case of Metastatic Prostate Cancer Presenting as a Massive Urinoma.

Urinoma formation as the first manifestation of carcinoma prostate is uncommon and has been reported only twice in the literature. We report a case of prostatic carcinoma in an elderly man who first presented in the emergency department with left-sided abdominal pain. His radiological investigations revealed a left-sided urinoma with dilatation of the entire ureter and an enlarged prostate with areas of varied intensity especially in the peripheral zone of the left lobe. In view of raised serum prostate-specific antigen (PSA) (155 ng/ml), a prostate biopsy was done, which showed features of adenocarcinoma (Gleason score 5+5). He was managed with pigtail drainage of urinoma, followed by double J stenting of the left ureter, and later underwent bilateral orchidectomy to reduce tumor burden, being metastatic disease. The stent was removed at a later date.

Incidental finding of metastatic prostatic adenocarcinoma of cerebellopontine angle presenting as acoustic neuroma: A case report and review of literature.

INTRODUCTION: Brain metastases from carcinoma of prostate are rare and only few cases with brain metastases preceding the diagnosis of carcinoma of prostate have been reported in the literature. Lesions of brain metastasis from prostate cancer had a large variety of imaging presentations and it is very difficult to distinguish them from the other types of brain occupying lesions. We report one case of metastatic prostatic adenocarcinoma of cerebellopontine angle presenting as acoustic neuroma, as the first clinical evidence of metastatic carcinoma of the prostate. PRESENTATION OF CASE: The 57-year-old male presented to the neurology clinic complaining of dizziness accompanied by right tinnitus, he was proposed to be diagnosed with acoustic neuroma, and the tumor resection was performed later in our neurosurgery department. The postoperative histopathological and immunohistochemical (IHC) examinations revealed a cerebellar pontine angle metastatic adenocarcinoma, which was then confirmed as prostate cancer metastasis. The patient refused surgical castration and only agreed to conservative treatment. The patient's condition continued to deteriorate, and he died 12 months after the initial presentation. DISCUSSION: Brain metastasis is rare in prostate cancer, which accounts for only 0.2 % to 2 % of all brain metastases. Intracranial metastasis as the first clinical symptom of prostate cancer is extremely rare. In our article, we report the VIIIth and VIIth cranial nerves palsy for the first time, caused by brain metastases from prostate cancer, with symptoms similar to an acoustic neuroma. Prostate cancer most commonly spreads to the bones, including the skull, Cranial nerve palsy is caused by extensive invasion of the skull base. The serum PSA level is considered the most valuable tool to monitor the disease progression of patients with prostate cancer metastasis. A high PSA level significantly increases the tendency of prostate cancer to metastasize to the brain. A high Gleason score is believed to help determine the risk and likelihood of brain metastases in patients with prostatic carcinoma. CONCLUSION: In our case, we initially report the VIIIth and VIIth cranial nerve palsy, mimicking an acoustic neuroma, caused by metastatic prostate carcinoma. For early diagnosis, the prostate should not be neglected as a possible source of the metastases in male patients presenting with brain metastases. High prostate specific antigen (PSA) level and high Gleason score can be useful parameters for the prediction of brain metastasis from prostate cancer. The PSA should play a vital role in distinguishing metastatic prostate carcinoma in male patients.

Metastatic Prostate Adenocarcinoma Presenting as Acute Quadriplegia: A Case Report and Racial Disparity Analysis.

Prostate cancer is the most frequently diagnosed malignancy in males with the highest incidence and mortality among African Americans. Most prostate cancers are low-grade and slowly progressive.  Prostate cancer can be asymptomatic in the early stages, as exemplified by diagnosis through incidental findings, but typically manifests as a change in urinary habits and characteristics, including frequency and dysuria. If diagnosed at the time of distant metastases, then the patient may complain of bone pain in the hips, legs, or feet, or lower extremity edema. We present the case of a 74-year-old African American male with no past medical history who presented to the emergency department with acute quadriplegia secondary to metastatic spinal cord compression. The patient required admission to the intensive care unit (ICU) and his quadriplegia was successfully treated with cervical arthrodesis, laminectomy, spinal instrumentation, and fusion, high-dose intravenous (IV) steroids, and physical and occupational therapy. Overall, the purpose of this case report is to critically review and investigate the factors behind a patient's atypical, rare, and underreported initial presentation of metastatic prostate cancer. The study discusses the literature on advancements in prostate cancer screening and highlights the importance of a broad differential. Most remarkably, the vignette prompts an analysis of the racial disparity gap in prostate cancer diagnosis and treatment demonstrates the need for further research toward improved health outcomes, and proposes multiple avenues to promote health equity.

Metastatic Prostate Cancer Presenting as a Rectal Polyp: A Rare Occurrence.

The prostate is anatomically located anterior to the rectum. Due to this proximity, locally advanced tumors of the prostate can invade the rectal tissue; likewise, colorectal cancers can invade the prostate gland; This presents mainly as an invasive mass with an identifiable primary and is rarely an isolated lesion. Prostate cancer rarely affects the gastrointestinal tract. Few cases of prostate cancer metastatic to the gastrointestinal tract have been reported in patients with a known prostate cancer history. Initial diagnosis of prostate cancer diagnosed from a colonic polyp is rare. We report a case of metastatic prostate cancer first diagnosed from a rectal polyp. Our patient is a 76-year-old man who initially presented with fatigue and 20 pounds weight loss in five months. The patient never had a colonoscopy before the presentation. A colonoscopy was done, which showed multiple colonic polyps and a pathology report of metastatic prostate cancer from a 12 mm rectal polyp.

Metastatic prostate carcinoma: A rare presentation initially misdiagnosed as a rib fracture.

Metastatic prostate carcinoma mainly occurs in bone as an osteoblastic lesion or lesions in the pelvis, spine, or chest wall. We present a unique case of a singular metastatic osteolytic lesion in the rib initially misdiagnosed as a fracture in a 61-year-old male. A single rib fracture in a patient with no history of trauma should raise suspicion for metastatic disease. We would encourage prostate cancer to be included in the differential diagnosis for an osteolytic lesion in a male over the age of 40. We review the current literature on this rare presentation of bone metastasis as well as the pathogenesis of metastatic prostate carcinoma as it relates to a solitary metastatic osteolytic lesion.

Genomic profiling screens small molecules of metastatic prostate carcinoma.

The aim of the present study was to investigate the pathogenesis of metastatic prostate carcinoma, to find the metabolic pathways changed in the disease and to screen out the potential therapeutic drugs. GSE38241 was downloaded from Gene Expression Omnibus; the Geoquery package was applied to preprocessed expression profiling, and the differentially-expressed genes (DEGs) were selected with limma (linear regression model packages). Next, WikiPathways cluster analysis was performed for DEGs on a Gene Set Analysis Toolkit V2 platform, and DEGs with hypergeometric algorithms were calculated through gene set enrichment analysis. A total of 1,126 DEGs were identified between the normal prostate and metastatic prostate carcinoma. In addition, KPNA4, SYT1, PLCB1, SPRED1, MBNL2, RNF165, MEF2C, MBNL1, ZFP36L1 and CELF2, were found to be likely to play significant roles in the process of metastatic prostate carcinoma. The small molecules STOCK1N-35874 and 5182598 could simulate the state of normal cells well, while the small molecules MS-275 and quinostatin could simulate the state of metastatic prostate carcinoma cells. In conclusions, the small molecules STOCK1N-35874 and 5182598 were identified to be good potential therapeutic drugs for the treatment of metastatic prostate carcinoma, while the two small molecules MS-275 and quinostatin could cause metastatic prostate carcinoma.

Skin Manifestation of Unsuspecting Prostate Cancer Detected by 18F-FDG PET/CT Performed To Assess Underlying Multiple Myeloma.

BACKGROUND: Skin metastases from either prostate adenocarcinoma or multiple myeloma rarely occur. We report the case of a 73-year-old man with multiple myeloma who presented with multiple subcutaneous nodules 3 years after his initial diagnosis. METHODS: Fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) imaging was suggestive of a concomitant second primary from the prostate. RESULTS: This case highlights not only a rare initial manifestation of prostate cancer, but also the role of 18F-FDG-PET/CT in detecting a clinically unsuspected second malignancy. CONCLUSION: It potentially corroborates the possible association of both diseases, as has been reported before.