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.