Metastatic Cutaneous Prostate Cancer – A case report of a rare presentation
Sunday, May 16th, 2021
Introduction: Prostate cancer is a leading cause of cancer morbidity and mortality in Australian men. Though prostate cancer is common, rarely does it present with cutaneous manifestations. Metastatic cutaneous prostate cancer represents less than 1% of all cutaneous metastatic disease and occurs in 0.06% to 0.3% of prostate cancer cases. This case report explores the rare presentation of cutaneous metastatic prostate cancer.
Case overview: An 83-year-old male with a history of metastatic castration-resistant prostate cancer presented with nodular chest lesions. The patient had been diagnosed with prostatic adenocarcinoma eight years earlier, and had received a radical prostatectomy, adjuvant radiotherapy, palliative chemotherapy, and androgen deprivation therapy. He was receiving palliative treatment at the time of presentation. The patient reported an eight-week history of firm, fast-growing flesh-coloured nodules over his right pectoral region which were otherwise asymptomatic. A prostate specific membrane antigen positron emission tomography scan demonstrated avidity within cutaneous lesions and was highly suspicious for cutaneous metastatic castration-resistant prostate cancer. The patient declined targeted radionuclide therapy and was managed with palliative superficial radiotherapy. The patient passed away six weeks after diagnosis of cutaneous metastases.
Discussion overview: Metastatic cutaneous lesions can result in diagnostic dilemmas for clinicians due to the rarity of presentations. Most cases will present with a known history of metastatic disease, however, a small number of cutaneous metastases may be the first indication of a clinically silent prostate cancer. Cutaneous metastasis is associated with a poor prognosis as there is often systemic disease present. Treating clinicians, including radiation oncologists, medical oncologists, dermatologists, urologists, and general practitioners, should consider the diagnosis of cutaneous metastasis in the case of skin lesions in prostate cancer patients.