title: Should prostate cancer be considered as a differential diagnosis in patients with osteolytic bone lesions?
abstract: OBJECTIVE
  Prostate cancer is the most frequently diagnosed cancer in men, as well as the second leading cause of death among cancers after lung cancer. In the United States, it is more prevalent in African-American men than in Caucasian men. Prostate cancer frequently metastasizes to the bone, with most of the reported lesions appearing to be osteoblastic on radiographs. Here, we describe an unusual presentation of metastatic prostate cancer with diffuse osteolytic bone lesions.
  
  
  METHODS
  An 80-year-old previously healthy Hispanic man presented with worsening back pain, difficulty with ambulation, and bladder outlet obstruction. Physical examination was significant for spinal tenderness in the thoracic and lumbar region. Digital rectal examination was remarkable for asymmetric enlargement of the prostate with nodularity and firmness. Imaging studies revealed diffuse osteolytic lesions. His prostate-specific antigen was 562.8 ng/mL (normal 0-4). Prostate biopsy and imaging studies confirmed a diagnosis of metastatic prostate cancer.
  
  
  CONCLUSIONS
  This case demonstrates that bone metastases of prostate cancer are not purely osteoblastic although most of the reported bone metastases in prostate cancer have been osteoblastic in nature. Therefore, clinicians are to consider metastatic prostate cancer as a differential diagnosis for patients with osteolytic bone lesions.
authors.affiliation: Department of Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, New York, USA. sunyoung.s.lee@mssm.edu.
authors.forename: M U
authors.initials: MU
authors.lastname: Bakhsh
authors.forename: S
authors.initials: S
authors.lastname: Lee
authors.forename: S
authors.initials: S
authors.lastname: Ahmad
authors.forename: J
authors.initials: J
authors.lastname: Takher
authors.forename: A
authors.initials: A
authors.lastname: Pareek
authors.forename: U
authors.initials: U
authors.lastname: Syed
authors.forename: J
authors.initials: J
authors.lastname: Seashore
authors.forename: E
authors.initials: E
authors.lastname: Szemraj
mesh_terms: D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000556:secondary; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D013904:Thoracic Vertebrae; D014057:Tomography, X-Ray Computed
chemical_list: D017430:Prostate-Specific Antigen