Unusual Presentations of Metastases in Carcinoma Prostate

Aim: The prognosis in prostate cancer mainly depends on presence or absence of metastases. Two patients presented to us with non specific signs and symptoms. Detailed history and examination could not help us to make any diagnosis. The histopathological examination of the biopsies at different sites led us to the diagnosis of prostate carcinoma. Our objective is to learn and introduce the rare presentations of metastases in carcinoma prostate.

Case Presentation: We present two unusual presentations of metastases in carcinoma prostate which were not suspected during the initial routine evaluation. One was a 75 yr male who presented with penile nodules which was later diagnosed to be carcinoma prostate. Other was a 76 year old man who had upper limb neuropathy which led us to the diagnosis of carcinoma prostate. The modes of presentation of these cases completely misled our evaluation and management protocol.

Discussion: Metastasis to penis occurs commonly from primaries in genitourinary tract: bladder (28.6%) and prostate (27.9%) followed by gastrointestinal tract. Metastatic spinal cord tumors occur in 10% of all cancer patients. Cervical spine involvement is relatively uncommon, accounting for less than 10% of all spinal metastases. The most prevalent primaries which metastasize to spinal cord are lung, breast, prostate, kidney, and thyroid.

Conclusion: Overall survival in prostate carcinoma depends on early detection and management. Despite these rare presentations of prostatic carcinoma, urologists should have high index of suspicion coupled with low threshold for investigations so that early diagnosis and management is possible.