What question did this study set out to answer?

This research aims to identify and clarify the features of an underrecognized metastatic pattern in prostate cancer.

July 19, 2026Open Access

Peribronchial cuffing: an underrecognized pattern of prostate carcinoma metastases to the lung

TMTimothy W. MillerMemorial Sloan Kettering Cancer Center SSSusan F. SlovinMemorial Sloan Kettering Cancer Center RARania G. AlyMemorial Sloan Kettering Cancer Center

Key Points

This research aims to identify and clarify the features of an underrecognized metastatic pattern in prostate cancer.
Retrospective case series at a quaternary cancer center from February 2020 to June 2025.
Identified patients with radiographic evidence of peribronchial cuffing through multidisciplinary service review.
Analyzed clinical data, imaging findings, pathologic specimens, and next-generation sequencing results.
Nine patients exhibited lower lobe-predominant peribronchial thickening with 78% having right-sided lesions.
66% had mediastinal lymphadenopathy and 22% had concomitant parenchymal lung metastases.
66% of cases showed tumor TP53 gene alterations, and 55% of patients died within a median of 5.3 months from detection.

Abstract

Prostate cancer is a leading cause of cancer-related morbidity and mortality in men, with a subset of patients developing aggressive, castrate-resistant disease. We describe an underrecognized pattern of thoracic metastasis - peribronchial cuffing - in patients with advanced prostate cancer, with the aim to elucidate clinical, radiographic, and pathologic features and thus facilitate early recognition and management. This was a retrospective case series conducted at a quaternary cancer center between February 2020 and June 2025. Patients with prostate cancer and radiographic evidence of peribronchial cuffing were identified through a multidisciplinary service review. Clinical data were abstracted, radiographic cross-sectional imaging findings were independently confirmed, pathologic specimens were revisited for histochemical staining with H-scoring, and next-generation sequencing results were analyzed. A total of nine patients demonstrated lower lobe-predominant peribronchial thickening, with 78% exhibiting right-sided involvement. All lesions were FDG- and/or PSMA-avid on positron emission tomography studies. Mediastinal lymphadenopathy and parenchymal lung metastases were concomitantly present in 66 and 22% of patients, respectively. The median time from PSA rise from baseline to cross-sectional imaging was 12.9 months, and from imaging to biopsy was 3.8 months. Tumor TP53 gene alterations were found in 66% of cases. In 33% of patients, the diagnosis of peribranchial metastases resulted in cancer upstaging. On follow-up, 55% of patients died within a median of 5.3 months from radiographic detection. Peribronchial metastasis represents a rare and underrecognized pattern of advanced prostate cancer spread. Its subtle presentation may result in delays in diagnosis and treatment. Recognition of this pattern in patients with rising PSA can be facilitated by new-generation molecular PET imaging studies to guide earlier biopsy and treatment initiation. Future studies are needed to characterize the pathobiologic mechanisms underlying this form of prostate cancer metastasis.

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