Prostate Cancer Presenting With Isolated Mediastinal Metastasis: A Case Report

Prostate cancer typically metastasizes in a predictable pattern, most commonly to the axial skeleton through Batson's venous plexus with associated regional pelvic lymphadenopathy. Mediastinal lymph node involvement is rare and represents an atypical route of dissemination that may lead to diagnostic uncertainty, particularly when thoracic findings predominate. We present a case of a 56-year-old Hispanic male with no significant past medical history with biopsy-confirmed prostatic adenocarcinoma with hematogenous mediastinal spread. CT imaging revealed extensive mediastinal, retroperitoneal, and pelvic lymphadenopathy with prostatic enlargement. This case highlights mediastinal lymph node metastasis as an uncommon initial manifestation of advanced prostate cancer and underscores the importance of tissue diagnosis in patients presenting with atypical thoracic adenopathy. Recognition of unusual metastatic patterns improves the understanding of tumor biology and may prevent misdiagnosis.