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DOI: 10.1055/s-2006-932991
Metastasis of prostate cancer simulates Paget's sarcoma
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.