Case report: Robotically visualized and biopsy-confirmed peritoneal carcinomatosis as initial identification of metastatic prostate adenocarcinoma in a patient with a history of prostatic urethral lift

• Published in: Frontiers in oncology Vol. 13; p. 1284688
• Main Authors: Khan, Qateeb, Myers, Bryn, Bowar, Breann, Khan, Maryam, Mullaney, Henry, Gainey, Jordan, Schneider, Robert, Dahmoush, Laila, Nepple, Kenneth G, Byrne, James D
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 2023
• Subjects: metastatic prostate cancer (mPCa); peritoneal metastases; prostate cancer; RALP; robot-assisted laparoscopic radical prostatectomy; peritoneal metastases; prostate cancer; RALP; metastatic prostate cancer (mPCa); robot-assisted laparoscopic radical prostatectomy
• ISSN: 2234-943X; 2234-943X
• DOI: 10.3389/fonc.2023.1284688

Peritoneal carcinomatosis is a particularly rare presentation of prostate cancer. Here we report a rare clinical case of surgically identified peritoneal carcinomatosis at the time of a planned robotic prostatectomy in a patient with a history of prostatic urethral lift procedure. A 72-year-old man, with a history of urinary retention managed with tamsulosin, presented to his local urologist. Prostatic urethral lift procedures were performed for symptom management. After a definitive uptrend in his prostate-specific antigen (PSA) values, a biopsy was obtained, which demonstrated prostate adenocarcinoma. On presurgical multidisciplinary review, it was presumed that he had very high-risk localized prostate cancer. However, upon initiation of robotically assisted laparoscopic radical prostatectomy (RALP), he was noted to have numerous punctate white plaques on the peritoneum; biopsy of these lesions confirmed metastatic disease-for which the patient was starting on triple therapy per the PEACE-1 trial. The PSA level responded appropriately, decreasing from 16.8 to 0.08. Genetic testing was performed and returned negative for any clinically significant mutations. Our patient, diagnosed with peritoneal carcinomatosis during a planned RALP, highlights the importance of vigilant laparoscopic exam prior to this prostatectomy. Multidisciplinary discussion is crucial for individualized and optimal treatment planning.