Isolated peritoneal carcinomatosis from metastatic castration-resistant prostate cancer and associated biliary obstruction: A case report

Prostate Cancer With Peritoneal Carcinomatosis: A Robotic-assisted Radical Prostatectomy-based Case Series

OBJECTIVE

To aid in the diagnosis and treatment of patients with metastatic tumor seeding, an exceedingly rare phenomenon following minimally invasive urological surgery, additional case reports are needed.

MATERIALS AND METHODS

We report our experience with patients determined to have peritoneal carcinomatosis following robotic-assisted radical prostatectomy (RARP) and provide a descriptive summary of these unique cases.

RESULTS

Five cases of peritoneal carcinomatosis were identified, all of which occurred relatively late-between 8 and 13 years-following RARP. Four of the 5 cases had T3 disease at the time of prostatectomy. 68Ga-PSMA PET identified peritoneal carcinomatosis in 3 of 5 cases.

CONCLUSION

Certain clinical factors, such as advanced pathologic stage at the time of prostatectomy, may predict risk for carcinomatosis following RARP. Additionally, next-generation imaging modalities, such as PSMA PET, may aid in identifying these metastases and are likely to identify increasing numbers of these patients as next-generation imaging becomes more widely available. Continued documentation and classification of this atypical presentation are needed to improve our understanding and management of this phenomenon.

Isolated peritoneal carcinomatosis in prostate cancer: from a successful hormonal management to a review of the literature

Metastases from prostate cancer involve mainly the bone compartment. However, visceral metastases are found in up to 49% of metastatic patients, occurring mainly in late stages of the disease, and are correlated with poor outcome. Peritoneal carcinomatosis is rarely described in literature, particularly when not associated with other distant metastatic lesions. We present the management of a patient with prostate cancer progressing on androgen deprivation therapy with description of omental involvement on ⁶⁸Ga PSMA-PET. There was no ascite or other distant lesion, reflecting thus a specific tropism of the cancer in this patient who had no history of prostate surgery. Abiraterone acetate resulted in a long-lasting complete response. We also present a review focusing on this entity.

Isolated non-ascitic peritoneal carcinomatosis after robotic radical prostatectomy for prostate cancer: A case report

Oncologic recurrence can occur after Robot-Assisted Radical Prostatectomy. Prostate cancer metastasizes often in bones, however the peritoneum is infrequently targeted. Even more, peritoneal dissemination without any other organ involved especially the bones is very rare, only few cases are reported. Through the available literature we discuss about the presumed seeding theory leading to this atypical location for prostatic metastases. Here we report a case of isolated non-ascitic prostatic peritoneal metastases most probably due to iatrogenic spillage during surgery.

Prostate Cancer Nonascitic Peritoneal Carcinomatosis After Robot-assisted Laparoscopic Radical Prostatectomy: 3 Case Reports and Review of the Literature

Robot-assisted laparoscopic radical prostatectomy is one of the treatment options for localized prostate cancer, with an excellent disease control rate. However, these patients can experience late disease recurrence with metastatic dissemination. Peritoneal metastases are an uncommon recurrence site. Here, we discuss 3 cases of peritoneal metastases following robot-assisted laparoscopic radical prostatectomy and the mechanisms of peritoneal invasion. Through a literature review and our case reports, we postulate the existence of 2 distinct mechanisms of peritoneal invasion: one being iatrogenic, following a laparoscopic surgery with a well differentiated prostate cancer at a nonadvanced stage of the disease, the other involving the natural course of poor-prognosis tumors, even without surgery.