Hypercalcemia in Advanced Prostatic Carcinoma: A Rare Event

Abstract

Prostate cancer is typically associated with metastatic osteoblastic lesions, hypocalcemia and hypophosphatemia. Hypercalcemia is a rarely encountered phenomenon i.e. 1-2% in prostate cancer, although it is well associated with other malignant cancers involving breast, lung, head, neck and multiple myelomas. We present the case of a 63 year old Mexican man with history of advanced prostatic adenocarcinoma and trans-urethral resection of prostate presented to ER with nausea, vomiting, polydipsia and altered mental status. Clinically, he appeared dehydrated and pale, with no other remarkable findings. Laboratory findings indicated severe hypercalcemia with calcium-16.1 mg/dL, with imaging studies revealing extensive metastatic osteoblastic lesions. Our patient was treated with aggressive hydration, calcitonin and pamidronic acid, his clinical status improved with complete resolution of hypercalcemia. We have discussed the possible underlying mechanisms and their interplay involved in the presentation of hypercalcemia in prostate cancer, and that its occurence is unlikely due to skeletal metastases.