Prostate Cancer Differential Diagnoses

Updated: Sep 07, 2023
  • Author: Chad R Tracy, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Diagnostic Considerations

In most cases, the differential diagnoses of advanced prostate cancer do not present any difficulty. However, certain caveats must be considered.

Radiologic findings of bony metastases can mimic Paget disease of the bone. Although bony metastases are blastic in nature, lytic lesions can occur, resulting in pathologic fractures. In men treated with luteinizing hormone-releasing hormone (LHRH), osteoporotic fractures must be distinguished from pathologic fractures.

Neurologic manifestations should be underscored. Sudden onset of weakness of the legs in an elderly man with a history of prostate cancer should raise the suspicion of spinal cord compression, necessitating emergency treatment (spinal cord decompression). Although brain metastases with associated neurologic manifestations are rare, they do occur with enough frequency to deserve recognition.

Lymphomas can manifest as pelvic masses and bone lesions. Although coexistence of lymphomas with prostate cancer has been reported, it is extremely rare.

Transitional cell carcinoma (TCC) and sarcoma of the prostate are more common in men who have undergone prior pelvic radiation therapy for prostate cancer than in men who have not. (The reported incidence of prostatic TCC ranges from 21.8% to 36.7%, depending mainly on the manner of examination. [55, 56, 47, 48, 49, 50, 51, 53]  Over 90% of cases are associated with bladder cancer. [57] ) Likewise, squamous cell carcinoma of the prostate may be observed in men treated with hormone therapy. All of these can present as a large pelvic mass with or without metastases.

Differential Diagnoses