Metastatic prostate cancer with bone marrow infiltration mimicking multiple myeloma

Mathur, Pankaj; Alapat, Daisy; Kumar, Manoj; Thanendrarajan, Sharmilan

doi:10.1002/ccr3.1308

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…The incidence of simultaneous diagnosis of prostate cancer and lymphoid malignancies is reported to be approximately 1.2% ( 6 ), but synchronous occurrence of prostate adenocarcinoma and multiple myeloma is only reported in a few cases ( 3 , 4 , 6 ). Coexistence of plasma cell neoplasm and metastatic prostate carcinoma in the bone marrow has been described ( 6 , 7 ), but synchronous skeletal metastases from these malignancies affecting the same bone lesion as was found in our patient has never been reported.…”

Section: Discussionsupporting

confidence: 44%

Synchronous Bone Metastasis From Multiple Myeloma and Prostate Adenocarcinoma as Initial Presentation of Coexistent Malignancies

et al. 2018

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The radiographic appearance of bone metastases is usually determined by tumor histology and can be osteolytic, osteoblastic, or mixed. We present a patient with coexistent bone metastasis from multiple myeloma and prostate adenocarcinoma who exhibited synchronous bone involvement of both histologies within the same bone lesion, a rare phenomenon that has not been previously reported and led to atypical radiographic findings. The radiograph of a 71-year-old man with thigh swelling and pain demonstrated a lytic femoral lesion. Magnetic resonance imaging (MRI) confirmed a destructive process, but showed coexistent metaphyseal sclerosis. Multiple myeloma was suspected by demonstration of monoclonal gammopathy and confirmed by computed tomography (CT)-guided biopsy. Incidentally, CT demonstrated areas of sclerosis corresponding to T2 hypointensity on MRI. Further studies revealed osteoblastic spinal metastasis, prostate enhancement on CT and prostate-specific antigen (PSA) level of 90 ng/mL, concerning for concomitant prostate neoplasm. After endoprosthetic reconstruction, pathology of the femur identified both plasma cell neoplasm and metastatic prostate adenocarcinoma. An association between prostate cancer and multiple myeloma is hypothesized due to tumor microenvironment similarities and possible common genetic variations, however, coexisting bone metastases have never been reported. This unusual finding explains the discrepant imaging features in our patient and is evidenced that certain clinical situations merit contemplation of atypical presentations of common malignancies even if this leads to additional testing.

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Section: Discussionsupporting

confidence: 44%

Synchronous Bone Metastasis From Multiple Myeloma and Prostate Adenocarcinoma as Initial Presentation of Coexistent Malignancies

et al. 2018

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“…After our institutional multidisciplinary discussion, treatment of multiple myeloma was started with the CyBorD regime with the intention to go for autologous stem cell transplantation after getting a response and reasonable disease control. Induction chemotherapy followed by autologous stem cell transplant in transplant-eligible cases is the standard of care for managing MM [5,[10][11][12][13][14][15][16]. Androgen deprivation therapy with an injection of leuprolide at three-month intervals was started for prostate carcinoma with a plan to go for definitive radiation therapy in the future, which is the standard of care in locally advanced prostate cancer cases [3,4,[10][11][12][13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

“…Induction chemotherapy followed by autologous stem cell transplant in transplant-eligible cases is the standard of care for managing MM [5,[10][11][12][13][14][15][16]. Androgen deprivation therapy with an injection of leuprolide at three-month intervals was started for prostate carcinoma with a plan to go for definitive radiation therapy in the future, which is the standard of care in locally advanced prostate cancer cases [3,4,[10][11][12][13][14][15][16]. Since there is no significant interaction between the planned myeloma treatment and leuprolide, this treatment was very well tolerated, and the patient responded well to treatment for both multiple myeloma and prostate cancer.…”

Section: Discussionmentioning

confidence: 99%

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Association Between Synchronous Occurrence of Multiple Myeloma and Carcinoma Prostate: Literature Analysis in the Context of a Case Report

Kumar Upadhyay,

Kumar,

Kumar

et al. 2023

Cureus

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Carcinoma of the prostate is the second most common cancer in males, while multiple myeloma is the 17th most common cancer. The synchronous diagnosis of multiple myeloma and carcinoma of the prostate is a sporadic phenomenon with scarce published literature and a diagnostic and therapeutic dilemma. Here, we present a case of synchronous diagnosis of IgG and lambda subtypes of multiple myeloma with multiple lytic lesions, the revised international staging system (R-ISS 2), and non-metastatic acinar adenocarcinoma prostate, a very high-risk category. The patient received 25 weekly doses of cyclophosphamide, bortezomib, and dexamethasone (CyBorD)-based chemotherapy for myeloma and androgen deprivation therapy with injection leuprolide for prostate cancer. After reasonable disease control, the patient underwent an autologous stem cell transplant for multiple myeloma with melphalan at 140 mg/m2 and was offered definitive radiation therapy for prostate cancer. The potential association between carcinoma of the prostate and multiple myeloma has been hypothesized because of similarities in the tumor microenvironment. There are possible common biological pathways leading to co-stimulatory mechanisms, like interleukin-2 (IL-2), insulin-like growth factor 1 (IGF-1), stromal cell-derived factor 1 (SDF-1), and vascular endothelial growth factor (VEGF). However, they are not proven and warrant further research. This case highlights key areas of diagnosis and management of this sporadic occurrence, along with literature analysis and the need for further research, and is likely to be beneficial for clinicians in decision-making in future cases.

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“…[6][7][8] Bone marrow infiltration by cancer cells is reported in solid tumors and the prognosis in patients presenting with pancytopenia is poor. [9][10][11][12][13][14] Hiroshige and Eguchi reported two cases of metastatic castrate-sensitive prostate cancer with bone marrow infiltration, moderate thrombocytopenia, and disseminated intravascular coagulation (DIC). 10 Both patients were treated with ADT with improvement in thrombocytopenia and DIC.…”

Section: Discussionmentioning

confidence: 99%

A castrate-resistant metastatic prostate cancer patient with severe pancytopenia, successfully treated with docetaxel chemotherapy

Kunthur

2019

J Oncol Pharm Pract

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Introduction Prognosis of metastatic castrate-resistant prostate cancer is poor with a median survival of 12 to 36 months. Bone metastasis is common, and bone marrow metastasis occurs later in the disease course. The median survival in these patients after bone marrow involvement is less than six months. We report a case of castrate-resistant prostate cancer patient presented with severe pancytopenia due to bone marrow involvement of prostate cancer, treated successfully with docetaxel chemotherapy. Post chemotherapy, the patient became transfusion independent and prostate-specific antigen improved to 0.1 ng/ml from 1051 ng/ml. Case report A 70-year-old gentleman with a history of metastatic prostate cancer on androgen deprivation therapy and polycythemia vera presented to emergency room with dizziness and melena. Workup revealed severe pancytopenia with platelet count of 12k and hemoglobin of 4.5 gm/dl. Bone marrow biopsy confirmed diffuse involvement of bone marrow with prostate cancer. Prostate-specific antigen was 1051 gm/dl. Management and outcome: The patient received 14 units of packed red blood cell, 10 units of platelet transfusion within one week. Docetaxel chemotherapy was started along with thrombopoietin agonist romiplostim and pegylated filgrastim. He received five cycles of docetaxel treatment. Post chemotherapy, the patient became transfusion independent and prostate-specific antigen improved to 1.17 ng/ml from 1051 ng/ml. The patient is still alive one year after the presentation with good quality of life and the prostate-specific antigen further improved to 0.1 ng/dl. Conclusion This case suggests that selected patients with severe pancytopenia, due to bone marrow infiltration of prostate cancer, can be treated with docetaxel chemotherapy and romiplostim support with significant response. Docetaxel treatment may be beneficial to unpack the marrow and for quicker response in patients with good performance status.

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Metastatic prostate cancer with bone marrow infiltration mimicking multiple myeloma

Cited by 5 publications

References 11 publications

Synchronous Bone Metastasis From Multiple Myeloma and Prostate Adenocarcinoma as Initial Presentation of Coexistent Malignancies

Synchronous Bone Metastasis From Multiple Myeloma and Prostate Adenocarcinoma as Initial Presentation of Coexistent Malignancies

Association Between Synchronous Occurrence of Multiple Myeloma and Carcinoma Prostate: Literature Analysis in the Context of a Case Report

A castrate-resistant metastatic prostate cancer patient with severe pancytopenia, successfully treated with docetaxel chemotherapy

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