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Unusual presentations of prostate cancer: A review and case reports

View Article: PubMed Central

ABSTRACT

Objective: To report our institutional experience with some rare presentations of prostate cancer, as prostate cancer is a common problem and affects a large group of men during their lifetime, but a few studies report unusual presentations of metastatic prostate cancer.

Methods: All possible clinical and pathological data were collected for six relevant patients with prostate cancer and unusual metastases who were identified at our institution. PubMed was searched for unusual presentations of prostate cancer in the last 20 years (1982–2012) and all relevant publications were assessed. The authors discussed the reports and selected those articles of major clinical significance to include in a review.

Results: We identified 19 reports of major clinical significance and reviewed them. As in the cases from our institution, supraclavicular lymphadenopathy, isolated upper ureteric obstruction and severe obstructing constipation were some of the rare presentations encountered at other institutions, and reported mostly as sporadic case-reports.

Conclusion: Prostate cancer should be always considered in the differential diagnosis of elderly men presenting with supraclavicular lymphadenopathy, hydroureteronephrosis or constipation, even in the presence of a normal digital rectal examination and low serum total prostate-specific antigen (PSA) levels. PSA immunohistochemical staining should be used in doubtful cases.

No MeSH data available.


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Initial IVU showing the left PUJ obstruction.
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f0005: Initial IVU showing the left PUJ obstruction.

Mentions: A 62-year-old man presented with left loin pain that had started a few months previously. Ultrasonography showed left-sided grade 3 hydroureteronephrosis, and IVU confirmed a provisional diagnosis of PUJ obstruction. (Fig. 1). The patient had no LUTS and a DRE showed a hard irregular prostate, and the serum total PSA level was 142 ng/mL. Multi-slice CT showed a left peri-ureteric mass, enlarged left iliac and para-aortic lymph nodes, together with multiple lytic lesions in the vertebral spines. Fig. 2 shows the findings from CT. TRUS-guided prostatic biopsies confirmed the diagnosis of prostate cancer, Gleason 4 + 3. Bicalutamide 150 mg/day was started, followed later by injections with an LHRH analogue. At 2 weeks after the first dose of LHRH analogue IVU showed a marked improvement of the PUJ obstruction and the pain was resolved (Fig. 3).


Unusual presentations of prostate cancer: A review and case reports
Initial IVU showing the left PUJ obstruction.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4442930&req=5

f0005: Initial IVU showing the left PUJ obstruction.
Mentions: A 62-year-old man presented with left loin pain that had started a few months previously. Ultrasonography showed left-sided grade 3 hydroureteronephrosis, and IVU confirmed a provisional diagnosis of PUJ obstruction. (Fig. 1). The patient had no LUTS and a DRE showed a hard irregular prostate, and the serum total PSA level was 142 ng/mL. Multi-slice CT showed a left peri-ureteric mass, enlarged left iliac and para-aortic lymph nodes, together with multiple lytic lesions in the vertebral spines. Fig. 2 shows the findings from CT. TRUS-guided prostatic biopsies confirmed the diagnosis of prostate cancer, Gleason 4 + 3. Bicalutamide 150 mg/day was started, followed later by injections with an LHRH analogue. At 2 weeks after the first dose of LHRH analogue IVU showed a marked improvement of the PUJ obstruction and the pain was resolved (Fig. 3).

View Article: PubMed Central

ABSTRACT

Objective: To report our institutional experience with some rare presentations of prostate cancer, as prostate cancer is a common problem and affects a large group of men during their lifetime, but a few studies report unusual presentations of metastatic prostate cancer.

Methods: All possible clinical and pathological data were collected for six relevant patients with prostate cancer and unusual metastases who were identified at our institution. PubMed was searched for unusual presentations of prostate cancer in the last 20 years (1982–2012) and all relevant publications were assessed. The authors discussed the reports and selected those articles of major clinical significance to include in a review.

Results: We identified 19 reports of major clinical significance and reviewed them. As in the cases from our institution, supraclavicular lymphadenopathy, isolated upper ureteric obstruction and severe obstructing constipation were some of the rare presentations encountered at other institutions, and reported mostly as sporadic case-reports.

Conclusion: Prostate cancer should be always considered in the differential diagnosis of elderly men presenting with supraclavicular lymphadenopathy, hydroureteronephrosis or constipation, even in the presence of a normal digital rectal examination and low serum total prostate-specific antigen (PSA) levels. PSA immunohistochemical staining should be used in doubtful cases.

No MeSH data available.


Related in: MedlinePlus