An unusual presentation of metastatic prostate cancer in a 44-year-old man - A case report and review of the literature

Sep 21, 2026

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Prostate cancer is among the two most common non-cutaneous cancers in men and can present with atypical symptoms that lead to an incorrect initial diagnosis. This case report describes a rare neurologic manifestation of advanced metastatic prostate cancer in a young, low-risk man. Misdiagnosis of multiple sclerosis led to inappropriate treatment, followed by whole-body bone scanning and transrectal ultrasound-guided biopsy confirming metastatic disease. After docetaxel, LHRH analogue Zoladex, and abiraterone, PSA levels decreased substantially and the disease remained controlled.

LanguageEnglish

CategoryHealthcare

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Introduction

Case presentation

DOI: 10. 1002/ccr3 .8447 CASE REPORT An unusual presentation of metastatic prostate cancer in a 44-year-old man: A case report and review of the literature Homa Taheri1 | Pouya Ebrahimi2 | Pedram Nazari3 | Amirhosein Kefayat4 | Abbas Mahdavian5 1Cedars-Sinai Cardiology Department, Beverly Hills, California, USA 2Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 3Cancer Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 4Oncology Department, Isfahan University of Medical Sciences, Isfahan, Iran 5Urology Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Correspondence Pedram Nazari, Cancer Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. [Email:](Email: dr.pedramnazari@gmail.com)[ dr.pedramnazari@gmail.com](Email: dr.pedramnazari@gmail.com) Abstract Prostate cancer is one of the two most common non-cutaneous cancers in men. Its presentation might be with unusual symptoms and cause the wrong initial diagnosis. This case report discusses a rare neurologic manifestation of advanced metastatic cancer in a low-risk man. He had been receiving treatment for multiple sclerosis incorrectly due to unusual manifestations such as claudication and pelvic, leg, and shoulder pain. The patient underwent a whole-body bone scan and then a transrectal ultrasound-guided biopsy, which confirmed metastatic prostate cancer with a Gleason score between 7/10 and 10/10 in all samples. Following treatment with chemotherapeutic injections (docetaxel), luteinizing hormonereleasing hormone (LHRH) analogous (Zoladex), and testosterone-suppressing tablets (abiraterone), the disease has been under control and prostate-specific antigen (PSA) level has decreased significantly. The most common sites of metastasis are regional lymph nodes, bones, and lungs. However, there are reports about the spread of this type of cancer to other parts of the body. Although most patients are diagnosed when the tumor is localized to the prostate, in about 25% of patients, the disease is diagnosed when metastasis has occurred. Some markers can assist physicians in the diagnosis of this disease, such as the Prostate Health Index and the 4 K score. Key Clinical Message The diagnosis of prostate cancer should be considered in all age ranges of adult men. The long-distance metastasis might cause unusual presentations of the disease, such as neurologic, musculoskeletal, and dermatologic symptoms and signs far from the origin of the cancer, before genitourinary manifestations. It is crucial to keep the diagnosis of prostate cancer in mind for men with suggestive signs and symptoms that are not usually detected in this disease. KEYWORDS cancer, case report, early-onset, metastasis, prostate This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2024 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. Clin Case Rep. 2024;12:e8447 . [https://doi.org/10.1002/ccr3.8447](https://doi.org/10.1002/ccr3.8447) [wileyonlinelibrary.com/journal/ccr3](wileyonlinelibrary.com/journal/ccr3) 1 of 7 2 of 7 | TAHERI et al. 1 | INTRODUCTION Prostate cancer is one of the two most common noncutaneous cancers in men and the fifth main cause of death among both genders in the world.1 Although the risk of occurrence of this cancer is correlated with aging, the diagnosis of early prostate cancer has had an increasing trend during the past decade, which can be attributed to the emergence of screening methods.2 Screening tests such as Prostate Specific Antigen (PSA), have decreased the percentage of metastatic cancer and this cancer's mortality rate.3 On the contrary, the low specificity of this test has caused a large number of unnecessary biopsies. That's the reason new models of screening have been ev

FAQs

Why was the patient initially diagnosed with multiple sclerosis?

The disease showed unusual neurologic and musculoskeletal manifestations distant from the pelvis, leading clinicians to treat him as having multiple sclerosis for more than 5 years.

How was metastatic prostate cancer confirmed in this case?

A whole-body bone scan was performed, followed by a transrectal ultrasound-guided biopsy. The biopsy confirmed metastatic prostate cancer, with Gleason scores ranging from 7/10 to 10/10 across samples.

What treatments were used after the correct diagnosis?

The patient received chemotherapy with docetaxel, LHRH analogue therapy (Zoladex), and testosterone-suppressing treatment with abiraterone, resulting in a significant PSA decline and disease control.

Sep 21, 2026

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