Mean age at the time of initial diagnosis was 65.4 ± 5.6 years. Four of these patients were referred to the hospital presenting with a palpable painless mass on the left cervical neck, while one patient showed bilateral neck enlargement in the lymph nodes. All five patients had cervical lymphadenopathy as the initial presentation. The basic clinical details of these patients are given in Table 1. The five patients were all transferred to the Urology Department from other clinics four from Otorhinolaryngology and one from Oncology. Of 2,248 patients, only five males presented with enlargement of the cervical lymph nodes as the initial manifestation of metastatic prostate cancer. Results Basic information relating to the five cases Of these patients, only five males presented with enlargement of the cervical lymph nodes as the initial manifestation of metastatic prostate cancer and written informed consent was obtained from the patient. In this research study, we identified 2,248 patients who had been diagnosed with prostate cancer. And the source of the cervical lymph lodes was also confirmed by the pathological outcomes of the needle biopsy. The pathological findings of the prostate biopsies were the gold standard for diagnosing prostate cancer. The exclusion criteria were as follows: (1) prostate cancer had been diagnosed in another hospital prior to attendance at our hospital (2) there was an incomplete set of patient follow-up records. There were no restrictions with regards to the department at which the patient first presented. The inclusion criteria were as follows: (1) patients admitted to our hospital with a neck mass as the initial symptom and (2) the primary site was confirmed to be the prostate. Next, performed a retrospective review of all patients diagnosed with prostate cancer in our hospital between January 2010 and December 2021. Materials and methodsįirst, we gained approval from the Ethics Committee of the Second Affiliated Hospital at Dalian Medical University, and the permision for publication has been obtained from the patients or their representatives. We also provide a review of the current literature. Herein, we report five rare cases presenting with cervical lymph node enlargement as an initial diagnosis between January 2010 and December 2021 in our hospital. Besises, the presence of metastatic lymph nodes is a poor prognostic factor in patients with prostate cancer, and the survival rates are significantly reduced in such patients ( 6). However, distal metastases to the cervical lymph nodes are very rare, especially as an initial presentation for prostate cancer ( 4), the incidence of this condition is less than 0.15% ( 5). The axial skeleton and regional lymph nodes are the most common sites of metastases for prostate cancer,followed by the lungs, bladder, liver and adrenal glands ( 3). According to the latest data, there were 1,143,300 new cases of prostate cancer worldwide in 2020 ( 2). Prostate cancer is the second most common form of cancer in men ( 1). Hormone therapy based on abiraterone may yield a better response in such cases. The prognosis for patients presented with cervical lymphadenopathy as the initial presentation is usually poor. In conclusion, any elderly male presenting with cervical lymphadenopathy should be considered the possibility of prostate cancer, especially when the needle biopsy reveals adenocarcinoma. Case 5 was treated with hormonal and chemotherapy but died 8 months after diagnosis. Case 4 was administered with abiraterone, prednisolone and goserelin the treatment was effective and the patient has remained symptom-free for the last 24 months. Case 3 was still alive at the time of writing. Case 2 rejected regular hormonal therapy for personal reasons and died 6 months after the initial diagnosis. Case 1 developed into castration-resistant prostate cancer (CRPC) after 7 months and died after 12 months. The five patients were treated with hormonal therapy four received traditional hormonal therapy, including bicalutamide and goserelin one patient received hormonal therapy that included abiraterone and goserelin. The diagnosis was confirmed by needle biopsy of the suspicious lymph nodes and the serum prostate specific antigen (PSA) levels of all patients exceeded 100 ng/ml. In the current study, we describe five cases of metastatic prostate cancer in our hospital that presented with cervical lymphadenopathy as an initial symptom. 2Department of Emergency, Xijing Hospital in Xi’an City, Xi’an, Shanxi, ChinaĬervical lymphadenopathy as the initial presentation of metastatic prostate cancer is particularly uncommon, and easily misdiagnosed.1Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China.Yangyang Liu 1,2,† Zhihong Dai 1,† Jiange Hao 1 Liang Wang 1* Zhiyu Liu 1*
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