To the Editor:
Most endobronchial tumors we encounter are predominately of lung origin, with extrapulmonary metastases comprising just 1.1%.1,2 Primary prostate endobronchial metastases are extremely rare.3 We recently evaluated 2 such cases, however.
The first case was a 67-year-old otherwise healthy gentleman referred for investigation of a right middle lobe lesion (RML) detected on positron emission tomography on a background of prostate cancer, managed with resection and salvage radiotherapy 3 years earlier. The patient was symptom-free and examination was unremarkable as were his pulmonary functions. His prostate-specific antigen (PSA) at the time of presentation was mildly elevated. Bronchoscopy confirmed endobronchial tumor in RML bronchus (Fig. 1). Biopsy revealed adenocarcinoma and immunohistochemistry staining was positive for PSA (Figs. 2A, B).
The second patient was a 77-year-old nonsmoking man who underwent Ga-68 prostate-specific membrane antigen ligand positron emission tomography /computed tomography scan to investigate a rising PSA, having undergone radical prostatectomy 10 years earlier. It noted an intense pulmonary prostate-specific membrane antigen uptake in the left upper lobe. Endobronchial ultrasound-guided bronchoscopy revealed a large tumor obstructing the anterior segment of the left upper lobe bronchus (Fig. 3). Transbronchial biopsies diagnosed poorly differentiated adenocarcinoma, positive for CK7 and P540S, as well as focal PSA and weak prostate specific acid phosphatase staining, consistent with a prostate primary, Gleason score 8 (4+4).
Our 2 cases demonstrate that endobronchial prostate metastases may mimic primary lung cancer and may even be the sole site of recurrent disease. This emphasizes the importance of considering this diagnosis in patients with a prior history of prostate cancer. Immunohistochemistry can easily determine the origin on adenocarcinoma and we hope these cases highlight endobronchial involvement with prostate cancer. It should be considered in such patients.
Asha Bonney, MBBS*
Patrick Bowden, MBBS, FRANZCR†
Philip Antippa, MBBS, FRACS‡
Daniel Steinfort, MBBS, FRACP*
Departments of *Respiratory Medicine
‡Cardiothoracic Surgery, The Royal Melbourne Hospital, Parkville
†Division of Radiation Oncology, Epworth Healthcare, Melbourne, Vic., Australia
1. Steinfort DP, Antippa P, Irving LB. Endobronchial colorectal metastasis: case report and review of the literature. J Bronchology Interv Pulmonol. 2008;15:46–48.
2. Venuta F, Rendina EA, De Giacomo T, et al. Nd:YAG laser resection of lung cancer invading the airway as a bridge to surgery and palliative treatment. Ann Thorac Surg. 2002;74:995–998.
3. Gerogianni I, Gravas S, Papadopoulos D, et al. Endobronchial metastasis from prostate cancer. Int Urol Nephrol. 2008;40:961–964.