B46-33 Endobronchial Metastasis of Prostatic Adenocarcinoma

Cough is a very common complaint seen in pulmonary clinic. Although cough is a common symptom in patients with lung cancer, malignancy overall represents a very small proportion of those with cough (Kvale 2006). If secondary to malignancy, cough is more indicative of intra-luminal disease rather than parenchymal disease (Kvale 2006). Primary lung malignancy is the most common etiology of malignant airway tumor. Beyond this, breast, colorectal, and renal cancer are most likely to cause endobronchial metastases (Hameed 2020). Endobronchial metastases from prostatic adenocarcinoma are exceedingly rare, with only a handful of cases having ever been reported. We report a case of a 70-year-old male with prostatic adenocarcinoma with known pulmonary metastases that had previously undergone radiation therapy who presented to pulmonary clinic with cough and mild hemoptysis. His cough was refractory to bronchodilator therapy. Computed tomography (CT) and positron emission tomography (PET) were performed and were notable for scattered bilateral lung nodules and mediastinal lymphadenopathy with minimal to mild Prostate-Specific Membrane Activity (PSMA). Bronchoscopy was performed and was notable for endobronchial disease most prominent in the right lower lobe and left main stem bronchi. Endobronchial biopsies and excision were performed bilaterally, with pathology consistent with the patient’s known prostatic adenocarcinoma. Following his bronchoscopy and debulking of endobronchial disease, the patient reported that his cough and hemoptysis had improved. This case underscores the diagnostic and therapeutic role of bronchoscopy in malignant airway tumor. White light flexible bronchoscopy (WLB) remains the standard for direct visualization of endobronchial lesions, enabling the detection of masses, mucosal infiltration or polypoid growth (Ohtani 2012). Adjunctive imaging modalities - such as autofluorescence bronchoscopy (AFB) and narrow band imaging (NBI)—can enhance lesion detection (Zhang 2016). AFB distinguishes neoplastic from normal tissue based on autofluorescence differences, although its specificity is limited by inflammatory and fibrotic changes. NBI, by emphasizing mucosal microvascular patterns, helps identify neoplastic vascular changes—including dotted, tortuous, or abruptly ending vessels—common to both primary and metastatic endobronchial tumors. Together, these modalities expand the diagnostic capabilities of bronchoscopy and facilitate targeted intervention in malignant airway disease. This abstract is funded by: None