A Rare Presentation of Prostate Cancer: Osteolytic Lesions Found on Investigation of Cervical Spondylosis

Case Diagnosis: Patient is a 77-year-old male diagnosed with prostate cancer causing osteolytic lesions.

Case Description or Program Description: The patient has a history of cervical spondylosis and presented to the PM&R outpatient clinic for cervical pain. He last had a cervical MRI scan nine years prior, which showed spondylosis, facet arthritis, and moderate stenosis at C5-6, but no cord abnormality or compression, no radiation of pain, and no evidence of myelopathy on presentation. Trigger point injection was performed for myofascial pain relief.

Setting: Outpatient pain clinic

Assessment/Results: Following the injection, an updated cervical MRI revealed unexpected lytic bone lesions, prompting further evaluation with CT. Subsequent imaging and laboratory tests led to the unexpected diagnosis of prostate cancer.

Discussion (relevance): Prostate cancer commonly metastasizes to bone and usually presents with osteoblastic rather than osteolytic lesions. Because of this, the osteolytic lesions led to differentials like multiple myeloma and primary bone disorders. This patient’s MRI had shown an FDG-avid area in the prostate, prompting workup leading to diagnosis of metastatic prostate cancer – an unexpected finding given the lytic lesions. While MRI findings indicated the urology workup for this patient, the presence of lytic instead of blastic lesions in other patients can delay diagnosis if not properly evaluated. This presentation emphasizes the need for physicians to consider oncological workup in unexplained lytic lesions, even in patients with a history of degenerative spinal disease.

Conclusions: This case demonstrates the importance of considering potential malignancy in the differential for lytic bone lesions, despite chronic history of pain. Early workup and diagnosis can lead to appropriate and timely management.