Prostatic Metastasis of Renal Cell Carcinoma Successfully Treated with Sunitinib

Abstract

Metastases of renal cell carcinoma to the prostate gland are very rare. We present a case of a metastasis of renal cell carcinoma in the prostate which occurred 10 years after nephrectomy. Treatment with sunitinib was initiated and a notable response achieved.

Rediscovering Secondary Tumors of the Prostate in the Molecular Era

“…Generally, serum prostate-specific antigen (PSA) levels are normal, ranging from 0 to 4 ng/mL. 13,17 This observation is consistent with the notion that the abnormal secretion of this serine protease is a specific indicator of intrinsic prostatic disorder, but not necessarily of prostatic involvement by other concurrent conditions, including tumors originating elsewhere. 27 On digital rectal examination, the prostate gland may be enlarged and present abnormal nodules; however, cases with negative or nonrelevant physical features are more common.…”

“…5,17 Taken together, the mean age at diagnosis is 53 years (range, 23 to 83 y), with the youngest reported individual with a secondary tumor of the prostate being affected by a metastatic small cell carcinoma of lung origin. 15 Infections of the urinary tract refractory to antibiotic therapy in patients with a history of extraprostatic neoplasms might represent the first sign of secondary tumors of the prostate; however, prostatic metastases may also be asymptomatic.…”

“…10,15 MORPHOLOGY, MICROSCOPIC PATHOLOGY, AND DIAGNOSTIC ISSUES On macroscopic examination, the prostate involved by metastatic deposits is frequently enlarged and stony hard, with well-demarcated, typically unencapsulated, spherical lobulated masses that can be variable in shape and size, measuring up to 7 cm, and may have a firm textured cut surface. 13,17,23 However, given the spectrum of macroscopic features that primary prostate cancer may bear, these findings are not at all specific. 1 Histologically, secondary tumors of the prostate have the propensity to reproduce the morphologic features of the tumor of origin.…”

“…1). 17,43 These tumors demonstrate an excellent prognosis after radical prostatectomy in cases of solitary metastases, 19 whereas in multimetastatic settings, hypofractionated radiotherapy may be preferred to achieve symptom palliation and a longer locoregional control. 44 …”

“…Despite the current lack of a comprehensive understanding, clinicians and pathologists must be aware of the possibility of prostatic secondaries to optimize patients' management. Secondary tumors of the prostate spread more frequently from the digestive tract, 4-11 the lung, 3,[12][13][14][15] and the kidney, [16][17][18][19][20][21] although prostatic metastases from the urinary bladder, malignant melanoma, and testicular, upper-respiratory tract, adrenal gland, and thyroid tumors have also been described. 3,[22][23][24] Albeit secondary tumors of the prostate have been historically described as incidental autopsy findings and/or manifestations of disseminated diseases, 2 recent studies provided circumstantial evidences that the number of core biopsies or prostatic resections with metastatic involvement is increasing, in particular solitary metachronous epithelial secondaries (Table 1).…”