Exp Clin Endocrinol Diabetes 2006; 114 - P08_106
DOI: 10.1055/s-2006-932991

Metastasis of prostate cancer simulates Paget's sarcoma

C Metzner 1, G Nöldge 2, G Delling 3, PP Nawroth 1, C Kasperk 1
  • 1Ruprecht-Karls-University, Department of Medicine, Division of Osteology, Heidelberg, Germany
  • 2Ruprecht-Karls-University, Department of Radiology, Heidelberg, Germany
  • 3University of Hamburg, Center of clinical-theoretical medicine I, Department of Osteopathology, Hamburg, Germany

History and clinical findings: A 74-year-old man presented with bone pain of the right hip, night sweat and weight loss for 18 months. The diagnosis M. Paget was confirmed 4 months ago, but pain and elevated serum alcaline phosphatase levels remained despite treatment with i.v. bisphosphonates. The physical examination showed no specific abnormalities.

Investigations: Laboratory findings showed elevated levels of serum alcaline phosphatase, CA 19–9 and CEA. The radiographic and tomografic evaluation showed an agressive periostal reaction consistent with a paget's sarcoma. The biopsy of the bone revealed the presence of a prostate cancer, which was confirmed in the consequent prostate biopsy.

Treatment and course: Due to multiple bone and lung metastases the patient proved incurable and received palliative therapy with flutamide. He died 10 months later.

Conclusion: In patients with Paget's disease unresponsiveness to bisphosphonate treatment (permanently increased AP and sustained pain) requires radiological and clinical reevaluation of the diagnosis sometimes including bone biopsy.