Abstract
BackgroundProstate adenocarcinoma is the most frequent cancer type among men, followed by skin cancer. Patients with prostate cancer usually present lower urinary tract symptoms due to tumor involvement. Bone marrow invasion is associated with prostate cancer metastasis and is common if blastic lesions in bones are present but is very rare without a large bone involvement and uncommon as initial presentation.Case presentationWe present a case of an 86-year-old Caucasian man with bone marrow invasion of prostate cancer without urological or bone-related symptoms and without prostate nodules. His findings were dyspnea, fatigue, and tachycardia. We detail the complete investigation of the case until we found the accurate diagnosis. The patient started treatment, but he had no response and so the oncology team started palliative care.ConclusionBone marrow invasion as an initial manifestation of prostate cancer is not common, especially if no prostatic lesions are found. This report is important to provide additional information about prostate cancer management.
Highlights
Prostate adenocarcinoma is the most frequent cancer type among men, followed by skin cancer
Cancer is the second leading cause of deaths globally according to the World Health Organization (WHO)
Scintigraphy showed probable bone metastases in the blades and spinous process of L4 vertebra and right iliac crest. He underwent new tests 1 month later; these showed that hemoglobin was 6.2 g/dL, platelets 51,000/μL, leukocytes 3950/μL, total prostate-specific antigen (PSA) 84 ng/mL, and free PSA > 20.0 ng/mL. He was referred to an oncologist, who prescribed degarelix (240 mg—first dose and 80 mg once per week for maintenance) as palliative treatment for metastatic prostate cancer and indicated transfusion
Summary
The patient stated that the last PSA done 2 years ago was normal Because of this, he was referred to a urologist, who requested kidney and urinary tract ultrasound (US) and bone scintigraphy. He underwent new tests 1 month later; these showed that hemoglobin was 6.2 g/dL, platelets 51,000/μL, leukocytes 3950/μL, total PSA 84 ng/mL, and free PSA > 20.0 ng/mL. Because of these examinations, he was referred to an oncologist, who prescribed degarelix (240 mg—first dose and 80 mg once per week for maintenance) as palliative treatment for metastatic prostate cancer and indicated transfusion. The patient is still alive 1 year after the presentation
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