Prostate Carcinoma Metastatic to the Male Breast

Abstract

Case ReportA.S. was referred to this department in September 1988 with metastatic prostate carcinoma. Two years previously he had presented elsewhere with abdominal pain and weight loss. Cervical lymphadenopathy was noted and biopsy revealed poorly differentiated adenocarcinoma in the lymph nodes. Computed tomography at that time revealed retroperitoneal lymphadenopathy and the patient received chemotherapy. Three months later sclerotic bone metastases were noted, a diagnosis of prostatic carcinoma was made and the patient was treated with stilboestrol with a good response. In May 1988 he was seen by the Radiotherapy Department at this hospital with severe bone pain and was treated by half-body irradiation, again with a reasonable response. At this stage he stopped using stilboestrol. When seen by us he complained of weight loss, pain, enlarged lymph nodes and painful enlarged breasts. On examination he was cachexic and cervical and axillary lymphadenopathy was noted. There was also marked bilateral gynaecomastia which was stony hard in consistency. Rectal examination revealed a small clinically benign prostate. Total acid phosphatase was raised at 324.2 u/l (normal range 4.8-13.5) with a prostatic fraction of 272.7 u/l (normal < 3.7).Alkaline phosphatase was 235 u/l (normal range 30-85) and lactate dehydrogenase 662 u/l (normal range 100-350).

Breast metastasis from prostate cancer and interpretation of immunoreactivity to prostate‐specific antigen

“…Patients known to have prostate malignancy and found to have breast enlargement may hence have the following differential diagnoses: (i) gynaecomastia related to hormonal therapy for prostate cancer; (ii) prostate cancer metastasized to the breast; (iii) breast cancer metastasized to the prostate; or (iv) double primary tumors. For prostate cancer metastasized to the breast, one possibility is that the gynaecomastia resulting from the hormonal treatment of prostate cancer increases the blood supply, hence encouraging metastasis 7 . In the case of double primary tumors, there can be a possible association between breast cancer and the use of estrogen therapy for prostate cancer.…”

Male breast cancer: is the scenario changing

“…Rare tumors like inflammatory carcinomas and sarcomas have also been described [ 64 , 65 ]. Metastasis to breast from tumors of prostate and lung is known [ 66 , 67 ]. In some series most of the tumors were noted to be of high-grade [ 68 ] whereas other series have shown predominance of grade 1 and grade 2 tumours [ 69 ].…”

Incidence of prostate cancer in male breast cancer patients: a risk factor for prostate cancer screening

“…Ironically, prostate cancer is the most common solid tumor to metastasize to the breast. 13 Steroid hormones play a role in both male breast cancer and prostate cancer. Prostate cancer is androgen-dependent and androgen responsive, whereas male breast cancer is estrogen dependent and generally hormonally responsive.…”