Progression to bone-marrow carcinomatosis and extraosseous legion during treatment with radium-223 for multiple bone metastases

Two cases of prostate cancer with disseminated carcinomatosis of the bone marrow treated with novel hormonal agents

Introduction

Disseminated carcinomatosis of the bone marrow in prostate cancer is rare and has a poor prognosis. Although strong evidence suggests that novel hormonal agents improve the prognosis of metastatic prostate cancer, their effectiveness in cases of disseminated carcinomatosis of the bone marrow remains unclear.

Case presentation

We encountered two cases of prostate cancer with disseminated carcinomatosis of the bone marrow at the time of initial diagnosis. One patient was treated with enzalutamide, abiraterone, docetaxel, cabazitaxel, denosumab, and radium-223 and died 38 months after the initial diagnosis. The other patient was treated with apalutamide and denosumab, and had progression-free survival for 17 months after the initial diagnosis.

Conclusion

These results suggest that novel hormonal agents may improve the prognosis of prostate cancer even in patients with disseminated carcinomatosis of the bone marrow.

Disseminated carcinomatosis of the bone marrow caused by prostate cancer diagnosed with only bone marrow biopsy

INTRODUCTION

Disseminated carcinomatosis of the bone marrow caused by prostate cancer is a rare condition with poor prognosis. Diagnosis has mostly been by primary prostate biopsy.

CASE PRESENTATION

A 60-year-old man had malaise, low platelet count (9000/μL), and high prostate-specific antigen (1382 ng/mL). Bone marrow biopsy showed strongly positive immunostaining NKX3.1, leading to diagnosis of prostate cancer bone marrow metastasis, cT3aN1M1b. Definitive diagnosis by prostate biopsy was difficult because of the sparsity of atypical glands. He had progression to castration-resistant prostate cancer after 3 months of hormonal therapy, and received 27 courses of docetaxel and six courses of cabazitaxel as chemotherapy, but finally died of respiratory failure 33 months after the start of treatment.

CONCLUSION

Aggressive biopsy of the metastatic sites should be considered if a prostate biopsy at the primary site cannot be diagnosed definitively.