Cervical lymphadenopathy as initial presentation of metastatic prostate cancer: A retrospective study of five cases and literature review

Abstract

Cervical lymphadenopathy as the initial presentation of metastatic prostate cancer is particularly uncommon, and easily misdiagnosed. In the current study, we describe five cases of metastatic prostate cancer in our hospital that presented with cervical lymphadenopathy as an initial symptom. The diagnosis was confirmed by needle biopsy of the suspicious lymph nodes and the serum prostate specific antigen (PSA) levels of all patients exceeded 100 ng/ml. The five patients were treated with hormonal therapy; four received traditional hormonal therapy, including bicalutamide and goserelin; one patient received hormonal therapy that included abiraterone and goserelin. Case 1 developed into castration-resistant prostate cancer (CRPC) after 7 months and died after 12 months. Case 2 rejected regular hormonal therapy for personal reasons and died 6 months after the initial diagnosis. Case 3 was still alive at the time of writing. Case 4 was administered with abiraterone, prednisolone and goserelin; the treatment was effective and the patient has remained symptom-free for the last 24 months. Case 5 was treated with hormonal and chemotherapy but died 8 months after diagnosis. In conclusion, any elderly male presenting with cervical lymphadenopathy should be considered the possibility of prostate cancer, especially when the needle biopsy reveals adenocarcinoma. The prognosis for patients presented with cervical lymphadenopathy as the initial presentation is usually poor. Hormone therapy based on abiraterone may yield a better response in such cases.

Cervical Lymphadenopathy: Could it be prostate cancer?

“…For such patients, the survival rates are significantly reduced. Interestingly, owing to the underlying widespread metastatic disease, cervical lymphadenopathy has a rather strong association with PSA levels beyond 100 ng/ml; with 26 / 29 patients (89.6%) satisfying this biochemical finding [8]. Even in the current case, our patient had a PSA level of 364.8 ng/ml at time of presentation.…”

Metastatic prostatic adenocarcinoma presenting as generalized lymphadenopathy unmasked by a COVID booster vaccine

“…It is interesting to note that only 7 of the 58 patients presented with right‐sided supraclavicular lymphadenopathy since more commonly, retrograde lymphatic spread via the left jugular trunk leads to the left‐sided cervical lymph nodes. 5 Though we obtained biopsies only from the right supraclavicular node and prostate, the distribution of other enlarged lymph nodes and their decrease in size following androgen deprivation therapy, together with decline in PSA from 121 ng/mL to 1.3 ng/mL favors the assumption that the generalized lymphadenopathy was secondary to metastatic spread and not any other secondary or additional diagnosis. COVID‐19 vaccination has been noted to be safe and effective in the elderly with lower adverse events reported compared to younger populations.…”

“…In a recent literature review, Liu et al note that 58 cases have been reported where cervical lymphadenopathy is the initial presentation of metastatic prostate cancer. It is interesting to note that only 7 of the 58 patients presented with right‐sided supraclavicular lymphadenopathy since more commonly, retrograde lymphatic spread via the left jugular trunk leads to the left‐sided cervical lymph nodes 5 . Though we obtained biopsies only from the right supraclavicular node and prostate, the distribution of other enlarged lymph nodes and their decrease in size following androgen deprivation therapy, together with decline in PSA from 121 ng/mL to 1.3 ng/mL favors the assumption that the generalized lymphadenopathy was secondary to metastatic spread and not any other secondary or additional diagnosis.…”

Metastatic Prostatic Adenocarcinoma Presenting as Generalized Lymphadenopathy Unmasked by a COVID Booster Vaccine

“…In a recent literature review, Liu et al note that 58 cases have been reported where cervical lymphadenopathy is the initial presentation of metastatic prostate cancer. It is interesting to note that only 7 of the 58 patients presented with right-sided supraclavicular lymphadenopathy since more commonly, retrograde lymphatic spread via the left jugular trunk leads to the left-sided cervical lymph nodes [5]. Though we obtained biopsies only from the right supraclavicular node and prostate, the distribution of other enlarged lymph nodes and their decrease in size following androgen deprivation therapy, together with decline in PSA from 121ng/ml to 1.3 ng/ml favors the assumption that the generalized lymphadenopathy was secondary to metastatic spread and not any other secondary or additional diagnosis.…”