Which conditions are included in the differential diagnoses of metastatic and advanced prostate cancer?

Updated: Dec 29, 2020
  • Author: Martha K Terris, MD, FACS; Chief Editor: Edward David Kim, MD, FACS  more...
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In most cases, the differential diagnoses of advanced prostate cancer do not present any difficulty; however, certain caveats must be considered.

Radiologic findings of bony metastases can mimic Paget disease of the bone. Although bony metastases are blastic in nature, lytic lesions can occur, resulting in pathologic fractures. Furthermore, osteoporotic fractures due to prolonged luteinizing hormone-releasing hormone (LHRH) therapy must be distinguished from pathologic fractures.

Neurologic manifestations should be underscored, and elderly patients with a history of prostate cancer who present to the emergency department with sudden onset of weakness of the legs should raise the suspicion of spinal cord compression, necessitating emergency treatment (spinal cord decompression). Similarly, although brain metastases with associated neurologic manifestations are rare, they do occur with enough frequency to deserve recognition.

Lymphomas can manifest as pelvic masses and bone lesions. Coexistence of lymphomas with prostate cancer has also been reported.

Transitional cell carcinoma and sarcoma of the prostate are more common in men who have undergone previous pelvic radiotherapy for prostate cancer than in men who have not. Likewise, squamous cell carcinoma of the prostate may be observed in men treated with hormonal therapy. All of these can present as a large pelvic mass with or without metastases.

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