Disclaimer & Credit: All medical articles including ours, are informative and provide population trends not specific to individuals which can be very different. Always seek personalized medical advice from your doctor for individual healthcare decisions.
Posted March 13, 2025PROSTATE CANCER IN 97-YEAR PATIENT
Case Study: A Complex Case of Metastatic Prostate Cancer in a 97-Year-Old Male
Introduction
This case highlights the diagnostic and therapeutic challenges in managing an elderly patient presenting with multifocal symptoms suggestive of malignancy. The combination of urinary complaints, systemic symptoms, and imaging abnormalities emphasizes the importance of a systematic approach to diagnosis and treatment.
Case Presentation
A 97-year-old male presented with difficulty urinating, pain in the waist and thighs, cough, nasal congestion, chest pain, abdominal pain, and dizziness.
Physical Examination Findings:
Drooling
Decreased muscle strength
Hard, non-tender mass in the left axilla
Reduced breath sounds in the left lung
Enlarged prostate
Bipedal edema
Vital Signs:
Temperature: 36.2°C
Pulse: 90 bpm
Blood Pressure: 136/80 mmHg
Oxygen Saturation: 97%
Initial Workup
Laboratory Findings:
Hemoglobin: 11 g/dL (anemia)
White blood cell count: 2.43 × 10³/µL (leucopenia)
Kidney function: Normal
Liver function: Normal
Prostate-specific antigen (PSA): 24.65 ng/mL (elevated)
HbA1c: 5.8% (normal)
Imaging:
Chest CT: Subpleural and intrapulmonary nodules, bronchiectasis, fibrosis, and a lytic lesion in the right 6th rib with cortical destruction
Differential Diagnosis
Metastatic Prostate Cancer – Most likely, given elevated PSA and lytic bone lesion
Primary Lung Cancer with Metastases – Less likely due to elevated PSA
Infectious Etiologies – e.g., tuberculosis; less likely given imaging features
Paraneoplastic Syndrome – Drooling and muscle weakness as possible neurological manifestations
Diagnostic Approach
Prostate biopsy to confirm adenocarcinoma
CT-guided biopsy of lytic rib lesion or axillary mass for metastasis evaluation
Bone scan to assess additional skeletal involvement
PSMA PET-CT for staging, if available
Treatment Plan
Systemic Therapy:
Androgen deprivation therapy (ADT) with leuprolide or goserelin
Bone-targeted therapy (denosumab or zoledronic acid) for lytic lesions
Consideration of docetaxel or AR-targeted agents (abiraterone, enzalutamide) if castration-resistant disease develops
Symptom Management:
Tamsulosin for urinary symptoms
Opioids and NSAIDs for pain control
Nutritional support for dysphagia due to drooling
Supportive Care:
DVT prophylaxis due to immobility risk
Multidisciplinary palliative care consultation for quality-of-life management
Outcome and Follow-Up
Transrectal ultrasound-guided prostate biopsy confirmed adenocarcinoma
Imaging showed widespread metastatic disease (ribs, lungs, lymph nodes)
Started on ADT and received radiation therapy for symptomatic bone metastases
Pain and urinary symptoms improved with therapy and supportive care
Ongoing follow-up with oncology and palliative care teams ensured continued symptom management
Discussion
This case illustrates the importance of considering malignancy in elderly patients with systemic complaints. Elevated PSA, lytic bone lesions, and pulmonary nodules strongly suggest metastatic prostate cancer. Early multidisciplinary involvement (oncology, radiology, palliative care) is essential for optimal outcomes. Genetic predispositions, such as HOXB13 and BRCA2 mutations, may increase prostate cancer risk in elderly patients.
Key Takeaways:
Maintain a high index of suspicion for malignancy in elderly patients with unexplained systemic symptoms
Conduct comprehensive workup (biopsies, imaging, labs) to confirm diagnosis and guide therapy
Balance curative and palliative strategies for holistic, patient-centered care
Conclusion
Metastatic prostate cancer in older adults presents unique challenges requiring a systematic diagnostic approach and integrated care plan. Combining evidence-based treatments with supportive care improves survival, symptom control, and quality of life for patients with advanced disease.