Discussion
Prostate cancer is one of the most common cancers that manifest as bone metastasis. The nature of the bone lesion in prostate cancer is typically osteoblastic, but osteolytic bony metastasis as first presentation has been reported.1,2 it’s not uncommon to see osteolytic lesion in prostate cancer as seen in one study by Cheville et al. which found that 16.4% of osseous prostatic cancer metastatic lesions were lytic but prostate cancer with first presentation of diffuse osteolytic lesion was not commonly reported .3Although the pathophysiology of prostate cancer was thought to be osteoblastic; emerging evidence suggests that the development of prostate cancer bone metastases requires osteoclastic activity and osteoblastic activity. Prostate cancer cells produce a variety of pro-osteoblastic factors that promote bone mineralization. In addition to factors that enhance bone mineralization, prostate cancer cells produce factors like the receptor activator of NFκB ligand (RANKL) that promote osteoclast activity .4 Indeed, Osteolysis has been implicated in tumor cell seeding and nourishment of tumor growth via the development of pro-tumorigenic changes in the microenvironment.5 clinicians and radiologists should keep in mind that prostate cancer can present with diffuse osteolytic lesions in a good proportion of patients and prostate cancer should be an important differential to be considered in such cases.