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Mahmoud AM, Moustafa A, Day C, Ahmed ME, Zeina W, Marzouk UM, Basourakos S, Haloi R, Mahon M, Muniz M, Childs DS, Orme JJ, Riaz IB, Kendi AT, Stish BJ, Davis BJ, Kwon ED, Andrews JR. Prostate Cancer Lung Metastasis: Clinical Insights and Therapeutic Strategies. Cancers (Basel) 2024; 16:2080. [PMID: 38893199 PMCID: PMC11171228 DOI: 10.3390/cancers16112080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Prostate cancer lung metastasis represents a clinical conundrum due to its implications for advanced disease progression and the complexities it introduces in treatment planning. As the disease progresses to distant sites such as the lung, the clinical management becomes increasingly intricate, requiring tailored therapeutic strategies to address the unique characteristics of metastatic lesions. This review seeks to synthesize the current state of knowledge surrounding prostate cancer metastasis to the lung, shedding light on the diverse array of clinical presentations encountered, ranging from subtle radiological findings to overt symptomatic manifestations. By examining the diagnostic modalities utilized in identifying this metastasis, including advanced imaging techniques and histopathological analyses, this review aims to provide insights into the diagnostic landscape and the challenges associated with accurately characterizing lung metastatic lesions in prostate cancer patients. Moreover, this review delves into the nuances of therapeutic interventions employed in managing prostate cancer lung metastasis, encompassing systemic treatments such as hormonal therapies and chemotherapy, as well as metastasis-directed therapies including surgery and radiotherapy.
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Affiliation(s)
- Ahmed M. Mahmoud
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA; (A.M.M.)
| | - Amr Moustafa
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY 11201, USA
| | - Carter Day
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA; (A.M.M.)
| | - Mohamed E. Ahmed
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA; (A.M.M.)
| | - Wael Zeina
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA; (A.M.M.)
| | - Usama M. Marzouk
- Department of Internal Medicine, Ain Shams University, Cairo 11566, Egypt
| | | | - Rimki Haloi
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA; (A.M.M.)
| | - Mindie Mahon
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA; (A.M.M.)
| | - Miguel Muniz
- Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Daniel S. Childs
- Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Jacob J. Orme
- Department of Medical Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Irbaz Bin Riaz
- Department of Medical Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - A. Tuba Kendi
- Department of Radiology, Division of Nuclear Medicine, Mayo Clinic, Rochester, MN 55905, USA;
| | - Bradley J. Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Brian J. Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA
| | - Eugene D. Kwon
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA; (A.M.M.)
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Nanashima A, Nagayasu T, Yamasaki N, Tsuchiya T, Matsumoto K, Tagawa T, Arai J. Lifetime Follow-Up of a Patient with Metastatic Prostate Cancer Undergoing Multiple Surgical Resections: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e941668. [PMID: 37939016 PMCID: PMC10642719 DOI: 10.12659/ajcr.941668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/28/2023] [Accepted: 09/14/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Prostate cancer (PC) often metastasizes after primary resection, and long-term survival following surgical removal of multiple pulmonary metastases is rare. We present a case of a surgeon who demonstrated long-term survival after overcoming repeated surgical challenges for multiple pulmonary metastases from PC. CASE REPORT Twenty-six years ago, a 62-year-old man initially reported discomfort during urination. A prostate examination revealed mildly elevated prostate-specific antigen (PSA) levels. Six months later, PC was diagnosed, and a radical prostatectomy was performed, revealing moderately differentiated adenocarcinoma but no vessel infiltration. At 9 years after the operation, three 10-mm nodules were detected in the right lung. Then, surgical biopsy by wedge pulmonary resection revealed metastatic PC, and therefore, right lower lobectomy including all nodules was planned. Although postoperative maintenance with luteinizing hormone-releasing hormone agonists kept the low PSA levels for 3 years, other newly limited metastases were observed in the opposite left lung, necessitating more surgeries of partial left lung resection. Six years later, a third lung metastasis was detected, as well as mild increases in the tumor size and PSA level, and the patient died 26 years after the initial PC intervention because of malnutrition for 1 year after sustaining bone compression fractures due to a fall, and not due to PC progression. CONCLUSIONS Repeated surgical resections for slow-growing metastatic pulmonary PC was an alternative treatment that facilitated favorable survival and a good quality of life for 26 years in the present case.
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Affiliation(s)
- Atsushi Nanashima
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, University of Miyazaki, Faculty of Medicine, Kiyotake, Miyazaki, Japan
- Department of Surgery Oncology, Nagasaki University, School of Biomedical Sciences, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgery Oncology, Nagasaki University, School of Biomedical Sciences, Nagasaki, Japan
| | - Naoya Yamasaki
- Department of Surgery Oncology, Nagasaki University, School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoshi Tsuchiya
- Department of Surgery Oncology, Nagasaki University, School of Biomedical Sciences, Nagasaki, Japan
| | - Keitaro Matsumoto
- Department of Surgery Oncology, Nagasaki University, School of Biomedical Sciences, Nagasaki, Japan
| | - Tsutomu Tagawa
- Department of Surgery Oncology, Nagasaki University, School of Biomedical Sciences, Nagasaki, Japan
| | - Junichi Arai
- Department of Surgery Oncology, Nagasaki University, School of Biomedical Sciences, Nagasaki, Japan
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Kokkalis A, Samara AA, Papadopoulos V, Tolia M, Tsoukalas N, Tsapakidis K. Metachronous Single Pulmonary Metastasis of Prostate Cancer: Report of a Rare Case and Literature Review. CANCER DIAGNOSIS & PROGNOSIS 2023; 3:157-162. [PMID: 36875299 PMCID: PMC9949549 DOI: 10.21873/cdp.10195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/01/2022] [Indexed: 03/07/2023]
Abstract
BACKGROUND Prostate cancer recurrence after definitive local therapy usually involves the bone and regional lymph nodes. CASE REPORT We present the case of a 72-year-old male patient with an isolated lung nodule, seven years after radical prostatectomy for prostate cancer, pT2bN0 and Gleason score 7(4+3), and prostatic-specific antigen (PSA) levels within normal limits. The nodule was considered as a primary lung cancer and the patient was subjected to lobectomy. The immunohistochemical staining showed that the tumor was PSA(+) and NKX3.1 (+), revealing that it was metastasis from prostatic cancer and that wedge resectomy was the proper procedure. Three years later the patient is disease-free, suggesting the importance of aggressive treatment of oligometastatic disease. CONCLUSION Metastasis to the lung is present in more than 40% of men with metastatic prostate cancer; however, lung metastases without any bone or lymph node involvement are extremely rare and only a handful of cases are reported in the literature. Surgical excision of the metastatic lung site is the most common therapeutic approach associated with a good prognosis.
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Affiliation(s)
- Alexandros Kokkalis
- Department of Medical Oncology, University Hospital of Larissa, Larissa, Greece
| | - Athina A Samara
- Department of Embryology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | | | - Maria Tolia
- Department of Radiotherapy, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Nikolaos Tsoukalas
- Department of Medical Oncology, 401 General Military Hospital, Athens, Greece
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Complete response in Patients With Lung-Only Metastatic Prostate Cancer: Outcome Analysis. Clin Genitourin Cancer 2022; 20:e485-e489. [PMID: 35680531 DOI: 10.1016/j.clgc.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/17/2022] [Indexed: 01/10/2023]
Abstract
Lung-only metastatic prostate cancer can be seen in 4.6% of patients and historically patients with visceral metastastic disease are considered high risk. In order to determine survival outcomes in this patient population, we conducted a restrospective review of patients with metastatic hormone sensitive prostate cancer with lung-only metastases. In this single institution review, 10 patients were identified with 8 achieving a complete response and 2 achieving a partial response when treated with androgen deprevation therapy (ADT) with or without metastastetomy. The median progression free survival was 64.4 months with 8 of these patients (80%) with ongoing complete response at time of follow-up. Lung-only metastases may serve as a good prognostic characteristic which will allow the clinician to treat with ADT alone with or without surgery to minimize treatment realted toxicity and still offer the ability to achieve a complete response with prolonged survival.
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Lyonga Ngonge A, Amadife SN, Wireko FW, Ikwu I, Poddar V. A Case Report on Atypical Presentation of Metastatic Prostate Cancer. Cureus 2022; 14:e20943. [PMID: 35154925 PMCID: PMC8815802 DOI: 10.7759/cureus.20943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 11/05/2022] Open
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Kosaka T, Iizuka S, Yoneda T, Otsuki Y, Nakamura T. Solitary pulmonary nodule as the initial manifestation of isolated metastasis from prostate cancer without bone involvement: A case report. Int J Surg Case Rep 2022; 90:106681. [PMID: 34953424 PMCID: PMC8715057 DOI: 10.1016/j.ijscr.2021.106681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/07/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction Isolated lung metastases from prostate cancer without any other organ involvement are rare. They are commonly in the form of diffuse or multiple lesions and rarely emerge as a solitary pulmonary nodule. Presentation of case A 61-year-old man who had undergone a laparoscopic-assisted radical prostatectomy for prostate cancer 16 months prior presented with a growing solitary pulmonary nodule. Positron emission tomography/computed tomography showed an abnormal uptake in the nodule without any other organ involvement. A surgical specimen by a thoracoscopic wedge resection proved a diagnosis of a metastasis from prostate cancer. He is currently alive only with worsening pulmonary metastases at 7 years after the lung surgery. Discussion A rare entity of isolated pulmonary metastases could be a sole finding of metastatic prostate cancer over the years and its initial manifestation could emerge as a solitary pulmonary nodule. It poses a diagnostic challenge because primary lung cancer is the leading differential diagnosis of solitary pulmonary nodules and is also one of the most frequent second primary malignancies in prostate cancer survivors. Conclusion An aggressive surgical biopsy is essential for definitive histopathological and immunohistochemical analyses of solitary pulmonary nodules to distinguish a rare form of an isolated pulmonary relapse from a second primary lung cancer in prostate cancer survivors. Isolated pulmonary metastasis without bone involvement from prostate cancer may rarely emerge as a solitary pulmonary nodule. Primary lung cancer is a leading differential diagnosis of solitary pulmonary nodules in general and is also one of the most frequent second primary malignancies in prostate cancer survivors. A surgical lung biopsy is a feasible option for a definitive histoimmunological diagnosis of solitary pulmonary nodules to distinguish a rare form of an isolated pulmonary metastasis from a second primary lung cancer in prostate cancer survivors.
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Affiliation(s)
- Tatsuaki Kosaka
- Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu-city, Shizuoka 430-8558, Japan.
| | - Shuhei Iizuka
- Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu-city, Shizuoka 430-8558, Japan.
| | - Tatsuaki Yoneda
- Department of Urology, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu-city, Shizuoka 430-8558, Japan.
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu-city, Shizuoka 430-8558, Japan.
| | - Toru Nakamura
- Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Naka-ku, Hamamatsu-city, Shizuoka 430-8558, Japan.
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