Beyond the Pelvis: Atypical Presentations of Prostate Cancer Mimicking Neurological and Head Neck Pathologies-selected Case Series from India

Abstract

Background: Prostate cancer is one of the most common malignancies among elderly men worldwide. Prostate carcinoma typically metastasizes to bone and regional lymph nodes. Cranial or extrathoracic metastases as initial presentations are exceedingly rare and can mimic neurological or head-and-neck pathologies, leading to diagnostic delay. Such cases are sparsely reported, and to our knowledge, no dedicated case series from India exists. Methods: We retrospectively analysed five patients who presented with atypical cranial or extra- thoracic manifestations and were subsequently diagnosed with metastatic prostate adenocarcinoma between 2020 and 2025 at our centre. Clinical, radiological, and histopathological data were reviewed. Results: Presentations included sudden-onset bilateral blindness due to optic canal metastasis (n=1), unilateral facial nerve palsy with skull base involvement (n=1), petrous bone lesion with facial nerve palsy (n=1), Sudden onset memory loss (n=1) and supraclavicular lymphadenopathy (n=1). Serum PSA ranged from 185–420 ng/mL. Imaging (MRI and PET-CT) demonstrated corresponding metastatic lesions. Biopsy or FNAC confirmed metastatic adenocarcinoma with PSA immunopositivity in all cases (insert result). All patients received androgen deprivation therapy, with selected cases receiving palliative radiotherapy. Partial neurological recovery was observed in two patients.333-- Conclusion: Cranial and extrathoracic metastases may rarely represent the initial manifestation of prostate carcinoma. Awareness of such presentations is crucial, as early prostate specific antigen testing and immunohistochemistry can facilitate prompt diagnosis and management. This represents the largest reported Indian case series describing these unusual initial manifestations of prostate cancer.