Abstract Introduction Lung cancer is the most prevalent primary malignancy reported globally followed by prostate cancer as the second most common malignancy in men. Prostate cancer may metastasize to any organ after definitive local therapy, and most commonly to bones and lymph nodes. There are 1% reported cases of isolated lung metastases without other extra-prostatic disease. This case report describes an even rarer case of concurrent primary lung and metastatic prostate adenocarcinoma within the same lobe of the right lung without extra-prostatic disease. Case report A 79-year-old gentleman was referred to Respiratory team with abnormal plain chest radiograph. He has a history of localised prostate cancer treated with mono-brachytherapy and Parkinson’s Disease. He is a non-smoker. High resolution computed tomography (HRCT) showed a new 8 mm nodule with mild surrounding ground-glass opacity as well as an enlarged 18 mm pericystic ground-glass nodule in the right upper lobe. Positron emission tomography CT (PET-CT) demonstrated a mildly avid anterior right upper lobe nodule and a cavitating right upper lobe lesion with no lymphadenopathy. (Figure 1) He was referred for a right upper lobectomy. Next generation sequencing (NGS) based analysis showed discordant mutational profiles on histology. Only tumour two showed typical variant for primary lung adenocarcinoma. Further immunohistochemistry for tumour one was positive for NKX3.1 with moderate staining for prostate-specific antigen (PSA), which confirmed diagnosis of metastatic prostates adenocarcinoma. Post-surgical resection, his PSA reduced to 0.08 from 3.11. Given the complete resection of his tumours, oncology team felt that the risk of further chemotherapy outweighed the benefit given his co-morbidities. Urology team opted to delay hormone therapy with ongoing PSA and PET monitoring. He is currently undergoing active surveillance. Discussion While surgical resection is first line treatment for T1 disease in lung cancer, hormone therapy is the most common treatment for metastatic prostate cancer. However, there are few successful reports of the sole usage of radical surgical excision in lung nodule metastases without extra-prostatic involvement. There is some evidence to support the use of surgery as the sole treatment in patients with normal PSA levels. The management remains controversial due to the rare nature of the presentation. It is especially complicated by patients with progressive underlying co-morbidities. There is the additional challenge where patients are under the care of multiple specialists. Due to the rare presentation, a multi-disciplinary approach with an efficient communication platform for different specialties has been proven to be essential in this scenario. This abstract is funded by: None
Lu et al. (Fri,) studied this question.