Solitary pulmonary nodule as the initial manifestation of isolated metastasis from prostate cancer without bone involvement: A case report

Abstract

Introduction Isolated lung metastases from prostate cancer without any other organ involvement are rare. They are commonly in the form of diffuse or multiple lesions and rarely emerge as a solitary pulmonary nodule. Presentation of case A 61-year-old man who had undergone a laparoscopic-assisted radical prostatectomy for prostate cancer 16 months prior presented with a growing solitary pulmonary nodule. Positron emission tomography/computed tomography showed an abnormal uptake in the nodule without any other organ involvement. A surgical specimen by a thoracoscopic wedge resection proved a diagnosis of a metastasis from prostate cancer. He is currently alive only with worsening pulmonary metastases at 7 years after the lung surgery. Discussion A rare entity of isolated pulmonary metastases could be a sole finding of metastatic prostate cancer over the years and its initial manifestation could emerge as a solitary pulmonary nodule. It poses a diagnostic challenge because primary lung cancer is the leading differential diagnosis of solitary pulmonary nodules and is also one of the most frequent second primary malignancies in prostate cancer survivors. Conclusion An aggressive surgical biopsy is essential for definitive histopathological and immunohistochemical analyses of solitary pulmonary nodules to distinguish a rare form of an isolated pulmonary relapse from a second primary lung cancer in prostate cancer survivors.

A Case Report on Atypical Presentation of Metastatic Prostate Cancer

“…It is actually unclear if the incidence of isolated prostate cancer metastasis to the lung is currently on the rise as we also noticed that in the past year, two similar cases were reported by Yoshitake et al and Kosaka et al [ 12 , 13 ]. However, the cases reported by Yoshitake et al and Kosaka et al showed that pulmonary metastasis was identified in their patients seven years and 1.5 years, respectively, after completing treatment for primary prostate cancer.…”

Prostate Cancer Lung Metastasis: Clinical Insights and Therapeutic Strategies

“…PCa lung metastasis may manifest with symptoms that primarily result from the spread of cancer cells to the lungs. In the early stages, individuals may not experience noticeable symptoms, and the metastasis may be asymptomatic [13][14][15]. However, as the disease progresses and the metastatic lesions affect lung function and adjacent structures, various symptoms may emerge.…”

“…PCa cells in lung metastasis often retain the glandular features seen in the primary tumor, aiding in their identification. The majority of lung metastasis in prostate cancer arise from prostate adenocarcinoma, given its status as the most prevalent histological subtype of PCa [14,15,49,50]. Nevertheless, less common histological subtypes, such as small cell carcinoma and neuroendocrine carcinoma of the prostate, have been documented [51][52][53][54].…”

“…By curtailing the production of testosterone and other androgens, ADT exerts palliative effects, effectively slowing the advancement of metastatic prostate cancer. This therapeutic strategy remains a cornerstone in the treatment arsenal, contributing significantly to improving patient outcomes [12,15,17,18,20,21,23,25,28,29,39,40,52,[62][63][64][65][66][67][68][69][70][71][72][73][74][75]. Another class which is the ARPIs represent promising therapeutic options in the management of prostate cancer lung metastasis, offering targeted inhibition of the androgen receptor pathway to impede disease progression and alleviate symptoms [29,74].…”

“…Moreover, emerging evidence supports the efficacy of stereotactic ablative radiotherapy (SABR), also known as stereotactic body radiotherapy (SBRT), in delivering high doses of radiation in a limited number of treatment sessions, thereby providing a convenient and effective treatment option for patients [83][84][85]. By delivering focused radiation to metastatic lesions, several studies showed that radiotherapy can induce tumor regression, improve local control, and complete resolution for patients with prostate cancer lung metastasis [12,15,24,29,41,49,73,87].…”