Atypical Prostate Cancer Presentation: Rectal Bleeding, Pain, and Psoriasiform

FRANK OBENG ^1* Aishah Fadila ² Samuel Edudzi Gavor ² Blessing Yao ² Ebenezer Kwame Antwi ² Afram Nelson ² Mahamudu Ali ¹

• ¹ University of Health and Allied Sciences, Ho, Ghana
• ² Ho Teaching Hospital, Ho, Volta, Ghana

Prostate cancer is typically asymptomatic and is usually diagnosed through concerted screening programs. However, in settings, where there are no existing national prostate cancer screening programs, it may be picked up at the clinics in patients presenting with urinary symptoms, erectile dysfunction, and haematospermia/haematuria. Rare, atypical presentations may also occur, delaying diagnosis and management. This case report discusses a 61-year-old male of Black-African descent, whose first presentation to the hospital for a condition ultimately diagnosed as metastatic prostate cancer, was because of lower gastrointestinal bleeding, rectal pain and psoriasiform dermatitis. The patient's clinical findings included a moderate-sized (grade 2) nodular prostate on digital rectal examination (DRE), a total serum Prostate Specific Antigen (PSA) level of >200 ng/mL, low back bonepain and osteoblastic lesions on lumbosacral spine X-ray. Prostate core biopsy histopathology confirmed adenocarcinoma with a Gleason score of 4+4=8. Histopathology of the synchronous skin lesions revealed psoriasiform dermatitis. The patient was managed with surgical androgen deprivation therapy (ADT), following oral bicalutamide, dermatologist consult and blood transfusions. He was also scheduled for further radiotherapy and chemotherapy (to complete his multimodality prostate cancer treatment). This case highlights the importance of considering prostate cancer in atypical presentations and underscores the need for a multidisciplinary approach in managing advanced cases.