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An Improbable Case of Ascites
Virginia Visconti1, Andre Fernandes1, Ismenia Oliveira1
1Internal Medicine Department, Beatriz Ângelo Hospital, Loures, Portugal.
Abstract:
Prostate cancer is the most frequent malignancy seen in males, with about 15% of cases showing metastatic disease at diagnosis, most commonly in bones (vertebrae, ribs, long bones). However, peritoneal metastasis with malignant ascites is extremely rare and may be overlooked by physicians. We report the case of a 77-year-old man presenting with symptoms of abdominal distension, nausea and weight loss. Abdominal ultrasound and computerised tomography confirmed ascites, peritoneal carcinomatosis and an enlarged prostate. Serum and ascitic prostatic-specific antigen were both elevated. Prostate biopsy identified a prostate adenocarcinoma, while biopsy of a peritoneal implant identified a prostate cancer metastasis, which responded well to hormonal therapy.
Learning Points:
Prostate cancer is the most frequent malignancy found in men, often metastasising to bones and lymph nodes.Although a rare site of metastasis, peritoneal cancer should be suspected when encountering a case of malignant ascites, in order to not delay diagnosis and treatment.Despite the generally poor prognosis of this malignancy, early diagnosis and hormonal treatment may lead to good clinical, symptomatic and analytical outcomes.
Insights
Peritoneal metastasis is a rare presentation of prostate cancer, often overlooked. Early diagnosis and hormonal therapy for this rare condition can lead to positive outcomes.
Area of Science:
- Oncology
- Urology
- Gastroenterology
Background:
- Prostate cancer is the most common male malignancy.
- Bone and lymph node metastases are common.
- Peritoneal metastasis with malignant ascites is a rare but critical presentation.
Purpose of the Study:
- To report a rare case of prostate cancer with peritoneal metastasis.
- To highlight the importance of considering peritoneal involvement in cases of malignant ascites.
- To demonstrate the effectiveness of hormonal therapy in such cases.
Main Methods:
- Case report of a 77-year-old male.
- Clinical presentation: abdominal distension, nausea, weight loss.
- Diagnostic tools: abdominal ultrasound, computed tomography, serum and ascitic PSA levels, prostate biopsy, peritoneal implant biopsy.
Main Results:
- Diagnosis of prostate adenocarcinoma with peritoneal carcinomatosis and malignant ascites.
- Elevated serum and ascitic prostatic-specific antigen (PSA) levels.
- Successful response to hormonal therapy.
Conclusions:
- Peritoneal metastasis from prostate cancer, though rare, must be suspected in patients with malignant ascites.
- Prompt diagnosis and initiation of hormonal treatment can lead to favorable clinical, symptomatic, and analytical results.
- This case underscores the importance of considering unusual metastatic patterns in advanced prostate cancer.
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