Partial Nephrectomy as Treatment of an Atypical Metastasis from Prostate Cancer—A Case Report and Review of Literature

Abstract

Background: Prostate cancer is the second most common type of cancer in man and the second in cancer-specific deaths in this population in the world. Most of the causes of death related to prostate cancer are due to its distant metastases, with the most common sites being: skeleton, distant lymph nodes, liver and lung. Renal metastasis is rare, and studies suggest infiltration due to arterial microembolization of the tumor. A key point in this scenario is the clinical suspicion of differential diagnoses, to offer the patient an effective therapy in such a specific case. Aim: To report a case of a patient with prostate cancer undergoing partial nephrectomy whose histopathological report revealed a metastatic lesion of that primary site. Case Presentation: 74 years old man, referred in May 2015 due to high PSA level and lumbago. PSA 323.11 ng/dl, rectal examination cT3a; biopsy was performed and histopathological study reported bilateral prostate adenocarcinoma, Gleason’s score 8 (4 + 4). Patient’s staging showed multiple secondary implants on skeletal scintigraphy. Tomography revealed solid exophytic lesion in the lower pole of the right kidney (4.7 × 3.6 cm); prostate without cleavage planes with seminal vesicles and pelvic node enlargement. Hormone therapy was initiated, PSA levels dropped to 9.51 ng/dl and total testosterone < 50 ng/dl. Partial nephrectomy was planned, initially by laparoscopy, but converted to laparotomy in December 2015. Procedure lasting 3 hours, minimal blood loss, no perioperative complications, discharged on the 3rd postoperative day. Histopathological report described undifferentiated malignant neoplasm, requiring immunohistochemistry that confirmed prostate adenocarcinoma. Patient remains hormone therapy, with no progression of the disease so far. Conclusion: Given the rarity of these cases, it is not possible to presume that nephrectomy enhances the survival rates. However, we observed that partial nephrectomy was a good choice for our patient, being the first case described in the literature. More reports should be available and studies with higher levels of evidence should be conducted to assist us in patient orientation and decision making.