Dramatic mixed response of lymphangitic pulmonary metastases in newly diagnosed prostate cancer

Prostate adenocarcinoma, the most common cancer in males in the United States, is often diagnosed in the nonmetastatic setting. The prognosis with metastatic prostate cancer is less favorable, though treatment options are typically effective in controlling the disease for an extended period. Hormonal therapy is the backbone to the management of prostate cancer metastases, decreasing the level of the prostate-specific antigen and reducing the patient's cancer-related symptoms. Pulmonary metastases, a relatively uncommon initial site of disease involvement, are expected to respond in a similar fashion to hormonal therapy as other organ or bone involvement. This report describes a patient with a newly diagnosed metastatic prostate cancer and a dramatic mixed response to hormonal therapy. This case should remind clinicians that pulmonary disease from prostate cancer may be an early metastatic finding, and can potentially progress even in the setting of an otherwise appropriate response to treatment.