A rare case of cutaneous, metastatic prostate cancer

Last week we learned of a distinctly unusual case of advanced prostate cancer, and the patient has given us his permission to provide our readers with some specific information about his case. We do this both to offer information about the very different ways that prostate cancer can sometimes evolve, but also in case any reader has specific knowledge that might be relevant to the management of this case.

DH, who lives in the southern US, was diagnosed with advanced (AJCC Stage IV) prostate cancer in about 2014 and had been treated over time with a spectrum of therapies for his cancer, including all the usual things like standard forms of androgen deprivation therapy (ADT) as well as sipuleucel-T (Provenge), enzalutamide (Xtandi), and other less common forms of therapy.

A little over 2 months ago, however, his cancer progressed again and spread cutaneously (through his skin and then across the skin of one of his thighs) as a form of metastatic skin cancer — apparently from the site of a 3-year-old needle biopsy (although this might be very difficult to actually confirm).

The fact that this really is metastatic prostate cancer is not in question because the tumor cells have been pathologically validated, and this has been confirmed through a second opinion from pathologists at a major academic institution.

The spread of the cancer in this way occurred over a period of just 60 days. Your sitemaster has been informed that, currently, the patient’s clinical team has been able to significantly slow the cutaneous spread of the cancer, but the patient also has significant lymphedema and other related problems (pain, nausea, etc.), and he reports that the cancer appears to be spreading through the sheaths of the nerves in his leg.

The following image shows the way in which this cancer has spread (and could be disturbing for some readers). We are aware that this form of prostate cancer progression can occur, but — as far as we are aware — it is an extremely unusual and rare manifestation of metastatic prostate cancer.

4 Responses

  1. Thank you Sitemaster for sharing this information, and to DH for permitting it to be shared. I have a couple of questions:

    (1) Is DH being treated at an NNCN institution? Or an NCI institution?
    (2) What treatment was administered to slow the progression?

    I am wondering if Lu177 radiation may be effective? Dr. Almeida has a trial available at very low cost to the patient; it is testing an alternate PSMA ligand to 617.

  2. Pretty gruesome!

  3. Rick:

    (1) As far as I am aware, DH is not being treated at an NCI or an NCCN institution. Even if he had been in the past, I think he has already reached the point where any travel is a real problem. He has let me know that just leaving the house at all is now difficult.

    (2) DH has not told me exactly what form of therapy has been used to slow the disease progression.

  4. G*d help us, and you, DH. Good luck. I do wonder about needle tracking. Like so many of these things, it is binary. I am told it is rare but for DH it (may be) 100%.

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