Case presentation
A 44-year-old Asian male who is not known to have chronic diseases and
presented with a 1-year history of dull aching backache. Initially, it
was mild, relapsing-remitting in nature, but it has become more
progressive lately. It is not related to movement and is present both
day and night. It was not associated with stiffness, but the patient
reported 8 kg unintentional weight loss during the last six months. The
patient reported some leg weakness also during the last few days. He
denied fever and sensory symptoms with no urinary or fecal incontinence.
The patient is a nonsmoker and drinks alcohol on social occasions. He
has no family history of cancer. The examination was unremarkable except
for mild lower limb weakness due to pain in the back and lower limbs.
Laboratory workups were shown a normal complete blood count and renal
function test. His serum alkaline phosphatase was 153 U/l, and serum
prostate-specific antigen was 633 ng/ml. MRI spine (image 1)revealed
widespread multiple variable size
osteolytic metastatic lesions in the cervical, dorsal, lumbar, and
sacral vertebral bodies and a few appendicular sites showing T1 low,
T2/STIR bright signal with postcontrast enhancement mainly at C5, C7,
T2, T3, T6, T7, T9, T11, T12, and to, L4, S1, and S2 levels. Computed
tomography of the abdomen and pelvis redemonstrated multiple spines and
diffuse destructive lytic pelvic bony lesions. It showed large expansile
soft tissue lesions with bony destruction involving bilateral sacroiliac
joints, multiple enlarged iliac lymph nodes, and an enlarged
non-homogenous prostate. PET scan confirmed our findings. CT-guided
right iliac Bone lesion biopsy was done, and histopathology showed
metastatic adenocarcinoma of prostatic origin. IHC stains for NKX3.1 and
AMACR showed that tumor cells are robust and diffusely positive and IHC
stain for PSA is focally positive. The patient was diagnosed with
metastatic prostate cancer, and we planned to start him on androgen
deprivation therapy and bone modifying therapy.