Prostate Cancer With Orbital Metastasis

Prostate cancer (PCa) is one of the most commonly diagnosed cancers in men worldwide, with an increasing incidence due to advancements in detection methods. The majority of PCa cases are sporadic, though a small percentage is hereditary. PCa primarily metastasizes to the bones, followed by lymph nodes, liver, and thorax. However, metastasis to atypical sites, including the orbit, remains exceedingly rare. Orbital metastasis from PCa is associated with a poor prognosis and can lead to significant visual impairment. This case report describes a 71-year-old male patient with a history of hypertension, atrial fibrillation, and obstructive uropathy, who presented with diplopia and left-sided ptosis. Imaging revealed a left intraconal orbital mass with intracranial extension, leading to the diagnosis of metastatic prostate adenocarcinoma. Further evaluation revealed extensive bone metastases and retroperitoneal lymphadenopathy. The patient was diagnosed with high tumor burden and castration-naïve metastatic PCa and treated with a combination regimen of androgen deprivation therapy, docetaxel, and darolutamide, resulting in significant reduction in prostate-specific antigen levels. Despite initial success in lowering tumor burden, the patient experienced side effects, including a rash, leading to discontinuation of chemotherapy. This case underscores the importance of considering PCa in the differential diagnosis of orbital tumors, despite its rarity. Surgical resection and palliative radiation were employed to manage the orbital mass, and ongoing treatment with denosumab was initiated to address the extensive bone metastases. This case highlights the clinical challenges and treatment considerations in patients with atypical metastatic spread of PCa and emphasizes the need for a multidisciplinary approach in managing such complex presentations.