Prostate cancer metastasis to the stomach

A case report on the atypical metastatic pathway of prostate cancer to the kidney and stomach

Prostate cancer rarely metastasizes to the stomach and kidneys. We report a 73-year-old male with such spread, highlighting significant clinical challenges. Initially diagnosed via biopsy and imaging, he received hormone therapy and cytoreductive radical prostatectomy. Despite initial management, the cancer progressed to metastatic castration-resistant prostate cancer, with gastric and renal metastases confirmed by imaging and biopsy. This case emphasizes the need for awareness of rare metastatic sites, comprehensive diagnostic evaluations, and further research into these atypical metastases to improve patient outcomes and develop better treatment strategies for managing advanced prostate cancer effectively.

Prostate Cancer Metastasis to Stomach: A Case Report and Review of Literature

Metastatic prostate cancer is a common diagnosis with a protracted but terminal course. Gastrointestinal (GI) tract involvement is extremely rare, and reportedly portends a poor prognosis. It can present years after the initial prostate cancer diagnosis. Only fifteen cases of prostate cancer metastasis to the stomach have been reported in the literature. We report a case of a 72-year-old man with metastatic castration-resistant prostate cancer and extensive bony involvement. He presented a decade after the diagnosis of prostate cancer with signs of heartburn; a gastric biopsy was initially believed to represent primary gastric carcinoma, but subsequently a diagnosis of prostate cancer metastatic to the stomach was confirmed. This case highlights the importance of the provision of a pertinent clinical history and clinical differential diagnosis at the time of submission of surgical pathology specimens, as well as highlighting the need to have a low index of suspicion to pursue additional pathologic markers whenever a presumed second adenocarcinoma is noted in the context of a patient having a history of current or prior advanced-stage adenocarcinoma of another site. The correct diagnosis can shield the patient from the morbidity of inappropriate surgical or medical management.

68Ga PSMA Uptake at Roux-en-Y Eso-jejunostomy Junction Mimicking the Recurrence of Gastric Carcinoma in PET/CT

A 67-year-old male patient had undergone total gastrectomy and Roux-en-Y eso-jejunostomy 3 years ago for the treatment of tubular adenocarcinoma located at the corpus of the stomach. The patient was diagnosed with Gleason score 8 (4+4) metastatic prostate cancer during the follow-up period and received hormone therapy. Owing to his elevated prostate-specific antigen levels (77 ng/mL), his clinician referred him gallium-68 (⁶⁸Ga) prostate-specific membrane antigen 11 (PSMA) positron emission tomography/computed tomography (PET/CT) for restaging. PET/CT showed multiple ⁶⁸Ga PSMA receptor-positive skeletal lesions and linear PSMA activity at the eso-jejunostomy junction. He was then referred to undergo ¹⁸fluorine-fluorodeoxyglucose (¹⁸F-FDG) PET/CT to screen for gastric carcinoma recurrence. PET/CT images demonstrated no ¹⁸F-FDG avid lesion. However, endoscopy and biopsy performed with samples from the eso-jejunostomy junction revealed superficial benign squamous epithelial fragments.

A rare case of PSA-negative metastasized prostate cancer to the stomach with serum CEA and CA19-9 elevation: a case report

Background

Metastatic cancer to the stomach is relatively rare. Prostate-specific antigen (PSA) is a reliable biomarker used in the screening and management of patients with prostate cancer. However, it is difficult to definitively diagnose a PSA-negative metastatic gastric tumor of prostate cancer because the cancer sometimes resembles primary gastric cancer in clinical images. It is also difficult to distinguish metastatic cancer from primary cancer even in the pathological examination of biopsy samples when the lesion is poorly differentiated adenocarcinoma. There is a possibility that the characteristics of the cancer are changed during treatment such as chemotherapy or radiation therapy. Therefore, careful consideration is required for surgical indication.

Case presentation

A 60-year-old male underwent radical prostatectomy and subsequent radiation therapy for advanced prostate cancer (pT3N1M0) 10 years previously, and hormone therapy was started for metachronous multiple bone metastasis 10 months before. Upper gastrointestinal endoscopy revealed an irregular depressed lesion with a convergence of folds at the greater curvature of the upper gastric body. Biopsy showed poorly differentiated adenocarcinoma that was negative for PSA upon immunohistochemistry. He had high serum carcinoembryonic antigen (CEA) (946.1 ng/ml) and carbohydrate antigen 19-9 (CA19-9) (465.1 U/ml) levels with no elevation of PSA (0.152 ng/ml). The tumor was diagnosed as primary gastric cancer based on the clinical imaging and pathological examination of the biopsy sample including the PSA staining. Based on the diagnosis, laparoscopic proximal gastrectomy with lymphadenectomy was performed. However, pathological examination of the resected specimen revealed poorly differentiated adenocarcinoma that was positive for other prostate markers such as androgen receptor. Thus, the patient was diagnosed with metastasized prostate cancer to the stomach.

Conclusions

We report a case of metastatic gastric cancer of prostate cancer 10 years after radical prostatectomy. In the present case, it was difficult to diagnose a metastatic gastric tumor of prostate cancer preoperatively, because of its resemblance to primary gastric cancer without PSA expression and no serum PSA elevation. Although a rare case entity, it is important to consider the possibility of a metastatic gastric tumor when the surgical indication is determined in cases with another co-existing cancer.

A case report of prostate cancer metastasis to the stomach resembling undifferentiated-type early gastric cancer

BACKGROUND

Occurrence of metastatic cancer to the stomach is rare, particularly in patients with prostate cancer. Gastric metastasis generally presents as a solitary and submucosal lesion with a central depression.

CASE PRESENTATION

We describe a case of gastric metastasis arising from prostate cancer, which is almost indistinguishable from the undifferentiated-type gastric cancer. A definitive diagnosis was not made until endoscopic resection. On performing both conventional and magnifying endoscopies, the lesion appeared to be slightly depressed and discolored area and it could not be distinguished from undifferentiated early gastric cancer. Biopsy from the lesion was negative for immunohistochemical staining of prostate-specific antigen, a sensitive and specific marker for prostate cancer. Thus, false initial diagnosis of an early primary gastric cancer was made and endoscopic submucosal dissection was performed. Pathological findings from the resected specimen aroused suspicion of a metastatic lesion. Consequently, immunostaining was performed. The lesion was positive for prostate-specific acid phosphatase and negative for prostate-specific antigen, cytokeratin 7, and cytokeratin 20. Accordingly, the final diagnosis was a metastatic gastric lesion originating from prostate cancer.

CONCLUSION

In this patient, the definitive diagnosis as a metastatic lesion was difficult due to its unusual endoscopic appearance and the negative stain for prostate-specific antigen. We postulate that both of these are consequences of hormonal therapy against prostate cancer.

Gastrointestinal Bleeding from Metastatic Prostate Adenocarcinoma to the Stomach

We present a rare case of gastrointestinal (GI) bleeding associated with metastatic prostate adenocarcinoma to the stomach. Prostate cancer, which is the most common noncutaneous malignancy among men, rarely spreads to the stomach, with only 7 cases reported in the English literature. Symptoms may include abdominal pain, nausea, vomiting, and GI bleeding. Our patient was treated with epinephrine injection and bipolar cautery, but GI bleeding recurred 7 months later when he had worsening of his thrombocytopenia while using ibuprofen.

Clinical and pathological features of metastatic adenocarcinoma of the prostate to the ileum

We present a case of a 74-year-old white male with a history of prostate cancer with unusual metastasis to the ileum, and with ileus as a very unusual first symptom of prostate cancer. This patient presented to us with histologically confirmed metastasis of the ileum after resection in the Department of Surgery.

Gastrointestinal metastases from prostate cancer: a review of the literature

ABSTRACT 

The availability of active new drugs for the treatment of advanced castration-resistant prostate cancer has significantly prolonged overall survival, thus changing the natural history of the disease and raising the likelihood of observing metastases in atypical sites. This review of the literature describes the frequency, clinical-pathological features and presenting symptoms of non-liver gastrointestinal metastases (GIm) from prostate cancer. Its purpose is to increase clinical awareness of the increasing incidence of such GIm, contributing to the early detection, accurate diagnosis and, when feasible, appropriate management.

Synchronous metastasis of prostate adenocarcinoma to the stomach and colon: a case report

Context:

Prostate cancer is the leading cancer diagnosis in males. The most common metastatic site of metastases in patients with prostate cancer is the axial skeleton and local lymph nodes. Rarely has there been a description of metastatic prostate cancer to the stomach, esophagus, small bowel, and rectum.

Case Report:

We report an unusual case of a patient who was diagnosed with prostate cancer with synchronous metastasis to both the stomach and sigmoid colon. A 71-year-old African American man with a history of prostate cancer was admitted with a hemoglobin level of 6.1 g/dl, which had decreased from the baseline value of 8 g/dl. He underwent an esophagogastroduodenoscopy, which revealed a nodule in the fundus of stomach; a biopsy of the nodule was done. The patient also underwent a sigmoid polypectomy. Both surgical specimens were histopathologically consistent with metastatic adenocarcinoma of prostatic origin.

Conclusion:

To the best of our knowledge, this is the first case report in literature of synchronous metastasis of prostate cancer to both the stomach and sigmoid colon.

Stomach metastasis in a patient with prostate cancer 4 years after the initial diagnosis: a case report and a literature review

Prostate cancer commonly metastasizes bones and lymph nodes, but it very rarely spreads to the gastrointestinal tract. However, only five cases of prostate cancer metastatic to the stomach have been previously reported in the literature. We report a case of a 69-year-old man with metastatic prostate cancer who presented with upper gastrointestinal bleeding (UGB) 4 years after the diagnosis. Esophagogastroscopy revealed multiple ulcerations in the gastric body and histopathological examination confirmed gastric metastasis that originated from prostate cancer. Chemotherapy could not be given because of patient's refusal. He was treated with LHRH agonist. We suggest that for a man with prostate cancer diagnosed with UGB, stomach metastasis should be considered in the differential diagnosis of UGB.