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Friday, October 4, 2013

Synchronous breast and prostate cancer


Only moderately odd, perhaps, but it's interesting to know that this happens: while ladies NEVER get prostate cancer for obvious reasons, men can get both prostate and breast cancer - and yes, they can even get both at the same time

Breast and prostate cancers are the most common cancer types in women and men, respectively. While breast cancer is uncommon in men (with an incidence rate of about 1 per 100 000 person-years), occasionally some poor bloke with prostate cancer is diagnosed as having breast carcinoma as well (or the reverse). Frequently, male breast cancer is diagnosed very late: the hard breast lump or changed nipple appearance is often overlooked until metastases appear, in the skeleton or elsewhere.

In 2007, a 90-year old Jewish man was brought to the emergency room of Hadassah Medical Center, Jerusalem, with a 2-month history of severe back pain. Over the last 2 weeks, his legs had been progressively weakening, and now he was suffering from constipation and an inability to urinate. He had been aware of a painless mass in his left breast for 5 years. Computed tomography showed numerous lytic lesions in his spine, where the bone was literally eaten away in places by cancer metastases. Some of the weakened vertebra had caved in and spinal cord compression had occurred. The patient was treated with dexamethasone to reduce spinal cord swelling - a standard treatment - and a biopsy was performed. It showed that the metastases were due to breast carcinoma. However, the patient also had a mass in his prostate, which turned out to be a second cancer, with different molecular characteristics. He had to be catheterized because of urinary retention (his bladder contained around 800 ml of urine - that's more than three glasses). He was treated with palliative ratiotherapy and hormonal agents, but died 2 months later from an urinary tract infection (Grenader and Shavit, 2007).

Earlier, in 1994, a male case of synchronous double cases of the breast and prostate was reported in Japan. An 84-year-old man was admitted to the Gifu Red Cross Hospital complaining of general malaise, lack of appetite and weight loss. A tumor 3 cm in diameter was noted in his left breast. It was removed by mastectomy and diagnosed as malignant. A lump was also found on his prostate, and a needle biopsy revealed adenocarcinoma (Tajika et al. 1994).

The literature also describes a case of a 73-year-old Portuguese man who presented with prostate adenocarcinoma metastasizing to the skin of his chest (prostate cancer frequently spreads to lymph nodes and to bone, but skin metastases are very rare), forming a number of stone-hard, brown, ulcerated nodules. Diffuse swelling on his chest made breathing difficult. There were no metastases to the skeleton or to the abdominal cavity, but the patient also had lumps in both of his breasts, and these lumps turned out to be... yup, you guessed it: bilateral breast cancer. He was treated with chemotherapy, which caused the swelling on his chest to go down and the nodules to regress, but he died a few months later from pneumonia (Cabral Ribeiro et al. 2008).



Numerous skin metastases from prostate cancer. Image from: Cabral Ribeiro et al. 2008

 
It seems like an extraordinary stroke of bad luck to suffer from two cancers at once, but one unfortunate Lebanese man actually suffered from FOUR. His case was described in the Southern Medical Journal in 2005. The patient, aged 65, was treated in Beirut for primary malignant cancers occurring simultaneously in four different organs. The tumors were: an adenosquamous cell carcinoma of the lung, transitional cell carcinoma of the urinary bladder, and adenocarcinomas of the prostate and the breast (Otrock et al., 2005). Whew! This case was probably due to some genetic abnormality.


Literature:

Cabral Ribeiro J, Marques Pereira T, Sousa L, Santos A. (2008) Skin metastasis in a patient with synchronous prostatic and breast cancer. Eur J Dermatol. 18(4): 470-1.

Grenader T, Shavit L. (2007) Synchronous male breast cancer and carcinoma of prostate in 90-year-old male, presented with spinal cord compression and multiple spine lytic lesions. Breast J. 13(4): 410-2.

Otrock ZK, Mahfouz RA, Salem ZM. (2005) Four primary tumors of lung, bladder, prostate and breast in a male patient. South Med J. 98(9): 946-9.

Tajika M, Tuchiya T, Yasuda M et al. (1994) A male case of synchronous double cancers of the breast and prostate. Intern Med. 33(1): 31-5.


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