An Unusual Case of Prostate Carcinoma With Metastasis to the Iliopsoas Muscle and Nerve Root Impingement

Kong, Joyce; Sumbly, Vikram; Idrees, Zarwa; Mahmood, Khalid

doi:10.7759/cureus.16286

Cited by 2 publications

(16 citation statements)

References 16 publications

(17 reference statements)

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“…Furthermore, it is extremely unlikely and rare for a patient to develop interval metastases at these sites. 3,[8][9][10] This is the first record where 177 Lu-PSMA SPECT/CT detected such uncommon metastatic locations. Hence, careful examination of PSMA localization post 177 Lu-PSMA therapy is crucial, regardless of clinical and biochemical implications.…”

Section: Figurementioning

confidence: 82%

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Cerebral and Muscular Metastases From Prostate Adenocarcinoma Initially Depicted by 177Lu-PSMA SPECT/CT

Al-Ibraheem,

Istatieh,

Abdlkadir

et al. 2024

Clin Nucl Med

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Cerebral and muscular metastases from prostatic adenocarcinoma occur rarely. Patients who develop such metastatic pattern exhibit noticeable symptoms. Herein, we present a 68-year-old man diagnosed with metastatic castrate-resistant prostate cancer. The patient received multiple 177Lu-PSMA cycles. After the last cycle, a posttreatment SPECT/CT suggested disease progression with uncommon metastatic pattern in the right temporal brain lobe and muscles. 68Ga-PSMA PET/CT and brain MRI confirmed these findings. Surprisingly, the patient remained asymptomatic up until the conclusion of the follow-up, which lasted for 3 months. This case emphasizes the importance of posttreatment scintigraphic imaging when other biomarkers are inconclusive.

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Section: Figurementioning

confidence: 82%

“…In our patient, there was an insignificant clinical manifestation complicating the issue at hand. Furthermore, it is extremely unlikely and rare for a patient to develop interval metastases at these sites 3,8–10 . This is the first record where 177 Lu-PSMA SPECT/CT detected such uncommon metastatic locations.…”

mentioning

confidence: 85%

Cerebral and Muscular Metastases From Prostate Adenocarcinoma Initially Depicted by 177Lu-PSMA SPECT/CT

Al-Ibraheem,

Istatieh,

Abdlkadir

et al. 2024

Clin Nucl Med

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“…Imaging in the form of a chest X-ray was used in one case to identify lesions [ 16 ]. Imaging in the form of a PET scan was used to identify lesions in five of the cases [ 2 , 10 , 13 , 15 ]. Imaging in the form of an MRI scan was used to identify lesions in six cases [ 1 , 2 , 13 , 25 , 26 ].…”

Section: Reviewmentioning

confidence: 99%

“…Four cases utilized epidural administration of local anesthetics with all displaying signs of pain resolution [ 22 , 26 ]. One case utilized lacosamide, an antiepileptic, but there was no information on its effectiveness [ 10 ]. Doxepin was used in one article and showed pain was effectively controlled and no pain with gain [ 4 ].…”

Section: Reviewmentioning

confidence: 99%

“…Dynamically, the psoas major flexes the hip, allowing the thigh to travel along the plane of the pelvis [ 4 , 8 , 9 ]. Although an uncommon occurrence, malignant infiltration of this muscle and its surrounding plexus of nerves are a significant contributor to the classical symptoms associated with MPS [ 10 , 11 ]. These symptoms include proximal lumbosacral plexopathy, ipsilateral nociceptive pain, or painful ipsilateral hip flexion with a positive psoas muscle stretch test [ 1 , 2 , 4 , 5 , 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Presentation and Management of Malignant Psoas Syndrome: A Scoping Review of Case Reports and Case Series

Suraj,

Zhang,

Appelbaum

et al. 2023

Cureus

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Malignant psoas syndrome (MPS) is a rare and underreported clinical syndrome that significantly impacts the quality of life of cancer patients through metastatic infiltration of the iliopsoas muscle. Patients suffering from MPS often present with painful hip flexion, loss of mobility, and immense pain in their legs and back. The current literature describing the clinical presentation, management, and prognosis of MPS is limited primarily to case reports and outdated literature reviews. There remains a gap in the current knowledge of MPS and in the management of this complex cancer-related pain syndrome. Thus, this scoping review aimed to map current case reports and case series on MPS for clinical presentation, treatment modalities, and resulting prognoses of MPS in late-stage cancer patients. A systemized search using the databases Embase and PubMed (Medline) was conducted to access case reports and case series published between January 1990 and October 2022 that met the study’s inclusion criteria: (1) adult patients with metastatic cancer; (2) MPS symptoms secondary to infiltration of iliopsoas; (3) clinical presentation, treatment modality, and prognosis; and (4) English-language text. Our search strategy yielded 1926 citations. After removing 629 duplicates, 1,283 reports were excluded due to failure to meet eligibility criteria (n=1,271) or inaccessibility (n=12). Using the JBI appraisal tools for case reports and case series, a total of 14 articles remained for the final review. With histories of either genitourinary, hepatic, gastric, or skin cancer, each case reported new onset intense pain in the legs, back, abdomen, or pelvis with associated symptoms such as flexion of the hip or gait disorder. A computerized tomography (CT) scan, magnetic resonance imaging (MRI), or positron emission tomography (PET) scan typically confirmed metastasis into the iliopsoas causing these symptoms, which suggested MPS. Each case utilized two to seven different pain management strategies to alleviate MPS symptoms. Many cases first used opioids for pain relief. Following a necessitated increase in morphine equivalent daily dose, a subsequent increase in the strength of analgesic, change in route of administration, and integration of combination drug therapy were generally added to the treatment regime. Many cases reported successful management of symptoms through utilizing methadone, radiation therapy, botulinum toxin injection, increased opioid dosage, or epidural catheter administration of opioids. A unified clinical definition of MPS may be required to inform physicians of this syndrome to help support clinical decisions regarding treatments for patients. The studies indicated that a clearer guideline for treatment protocol may be warranted as most cases reported utilizing various treatment medication dosages and procedures with vastly differing results.

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An Unusual Case of Prostate Carcinoma With Metastasis to the Iliopsoas Muscle and Nerve Root Impingement

Cited by 2 publications

References 16 publications

Cerebral and Muscular Metastases From Prostate Adenocarcinoma Initially Depicted by 177Lu-PSMA SPECT/CT

Cerebral and Muscular Metastases From Prostate Adenocarcinoma Initially Depicted by 177Lu-PSMA SPECT/CT

Clinical Presentation and Management of Malignant Psoas Syndrome: A Scoping Review of Case Reports and Case Series

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