[Choroidal metastasis from clinically regressed prostate adenocarcinoma: imaging of a rare case]

Choroidal metastases are often the revealing feature of malignant diseases. We report a rare case of prostatic adenocarcinoma metastases at the choroids, diagnosed and followed by fluorescein angiography (FA), indocyanine-green angiography (ICGA), and optical coherence tomography (OCT-3 Stratus).

A 54-year-old man was referred to our department for decreased vision in his left eye lasting for 1 month. On ophthalmic evaluation, best corrected visual acuity (BCVA) was 20/20 in his right eye and 20/63 in his left eye. Biomicroscopic examination of the anterior segments did not reveal anything abnormal in either eye. Funduscopic examination revealed two amelanotic choroidal masses in both his right and left eyes, located at the posterior pole and at the periphery. The systemic workup, including hematologic analysis and total-body computed tomography (CT), revealed elevated serum prostate-specific antigen (PSA) and alkaline phosphatase, extensive abnormalities of the axial skeleton, and nodular pulmonary shadows; therefore, prostatic adenocarcinoma was suspected. Needle biopsies (prostatic and pulmonary) confirmed adenocarcinoma of the prostate, with metastatic disease. We decided to submit the patient to intermittent total androgen blockade alone, without adjunctive radiotherapy. The patient responded well to intermittent total androgen blockade with oral bicalutamide and triptorelin injection alone, as documented on fundus pictures, ultrasonography, OCT, FA, and ICGA.

Prostatic carcinoma should be considered in any male patient with a choroidal mass suspected of being a metastasis. In our patient, FA, ICGA, and OCT clearly documented the complete regression of choroidal metastasis from prostatic carcinoma. Fluorescein angiography, indocyanine-green angiography, and optical coherence tomography are useful tools in the diagnosis and follow-up of prostatic adenocarcinoma metastatic to the choroid.