Chest Pain as a Symptom of Early-Onset Metastatic Prostate Cancer: Exploring the Role of Screening

Prostate cancer is one of the most prevalent malignancies affecting males, primarily occurring in older men. However, it has been observed that there is a growing trend of new cases among younger individuals. We present the case of a 35-year-old male who had experienced persistent, severe right-sided chest pain for three months, unrelieved by analgesics. An inpatient workup revealed elevated alkaline phosphatase, prompting a more thorough evaluation that included measuring prostate-specific antigen (PSA) levels. His CT scan revealed sclerotic lesions in the ribs concerning metastatic disease. A biopsy of the enlarged retroperitoneal lymph nodes confirmed the diagnosis of metastatic prostate adenocarcinoma. Due to the patient's age and strong family history, genetic testing was conducted, revealing a BRCA2 mutation. Chest pain in a young patient can be misleading, and his symptoms did not initially suggest prostate cancer as a primary differential diagnosis. However, the persistence of symptoms, imaging results, and a strong family history of prostate cancer directed the physicians toward the correct diagnosis. Additionally, BRCA2 mutations are linked to a more aggressive form of the disease, and a timely diagnosis can lead to better outcomes. However, there is limited data regarding routine screening in high-risk patients such as African Americans and those with genetic predisposition. Therefore, healthcare providers should collaborate with their patients to develop personalized screening plans.