Peritoneal carcinomatosis and prostatic cancer : a rare manifestation of the disease with an impact on management

As it has been recently noted in two papers published in the JBRTBR (1, 2), prostate cancer is the second cause of male-cancer related death. The role of radiologists is crucial at the early stage of the disease, for local and distant staging, and during the follow up of the patient. We would like to take the opportunity to report on an uncommon case of peritoneal carcinomatosis observed during the long term follow up of a patient having prostate cancer. Based on these findings, there was a need for change of therapy, with a positive impact on the outcome. Our 70 year-old patient has a diagnosis of prostate cancer since 8 years (2003), classified as Gleason 8 after surgery. Since 2009, he is treated with hormonal therapy (goserelin and bicalutamide). In June 2010, He presents asthenia requirProstate cancer is frequently related to lymph node invasion, bone metastases and sometimes liver and brain localizations (4, 6, 7). Uncommon metastases are reported in the eyes, the larynx and the peritoneal cavity (6, 7). When peritoneal carcinomatosis is detected in patients with prostate cancer, it can be an isolated finding or revealing the prostate cancer (6, 7). This can also be detected during surgery without being pre-operatively suspected; it can be also observed at the end stage of the disease (7). When histology of peritoneal nodule is available, it has been showed that neuroendocrine differentiation correlates with a poor prognosis (8). Some CT findings are suggestive of peritoneal carcinomatosis including the presence or ascites (a non specific finding), nodules in the fatty tissue of the peritoneal cavity (omentum, mesenteric roots, Douglas pouch), and nodules adjacent to the liver edge (8, 9). CT scan can help to ing medical advice. The blood tests are showing increased PSA level (from 33 ng/mL (02/09) to 407 ng/mL (06/10), nl < 4.0 ng/ml). An abdominal CT-scan is performed, showing a large amount of ascites in all the abdominal compartments, with tissular nodules closed to the right liver surface (Figs. 1 and 2). These findings were considered as signs of peritoneal carcinomatosis. Based on the clinical data, the PSA level and the imaging findings, chemotherapy is then initiated. Biological and imaging controls were normalized 9 months later, with persistence of a calcified centimetric nodule closed to the liver edge. At the present time, the patient disease is stable. Peritoneal carcinomatosis is frequently in the oncologic evolution of patients with colo-rectal cancer, gastric, pancreatic and gynecologic cancers (3). It has been uncommonly reported in prostate cancers (4-6). JBR–BTR, 2013, 96: 178-179.


Dear Editor,
As it has been recently noted in two papers published in the JBR-TBR (1, 2), prostate cancer is the second cause of male-cancer related death.The role of radiologists is crucial at the early stage of the disease, for local and distant staging, and during the follow up of the patient.We would like to take the opportunity to report on an uncommon case of peritoneal carcinomatosis observed during the long term follow up of a patient having prostate cancer.Based on these findings, there was a need for change of therapy, with a positive impact on the outcome.
Our 70 year-old patient has a diagnosis of prostate cancer since 8 years (2003), classified as Gleason 8 after surgery.Since 2009, he is treated with hormonal therapy (goserelin and bicalutamide).In June 2010, He presents asthenia requir-Prostate cancer is frequently related to lymph node invasion, bone metastases and sometimes liver and brain localizations (4, 6, 7).Uncommon metastases are reported in the eyes, the larynx and the peritoneal cavity (6, 7).
When peritoneal carcinomatosis is detected in patients with prostate cancer, it can be an isolated finding or revealing the prostate cancer (6, 7).This can also be detected during surgery without being pre-operatively suspected; it can be also observed at the end stage of the disease (7).When histology of peritoneal nodule is available, it has been showed that neuroendocrine differentiation correlates with a poor prognosis (8).
Some CT findings are suggestive of peritoneal carcinomatosis including the presence or ascites (a non specific finding), nodules in the fatty tissue of the peritoneal cavity (omentum, mesenteric roots, Douglas pouch), and nodules adjacent to the liver edge (8, 9).CT scan can help to ing medical advice.The blood tests are showing increased PSA level (from 33 ng/mL (02/09) to 407 ng/mL (06/10), nl < 4.0 ng/ml).An abdominal CT-scan is performed, showing a large amount of ascites in all the abdominal compartments, with tissular nodules closed to the right liver surface (Figs. 1 and 2).These findings were considered as signs of peritoneal carcinomatosis.Based on the clinical data, the PSA level and the imaging findings, chemotherapy is then initiated.Biological and imaging controls were normalized 9 months later, with persistence of a calcified centimetric nodule closed to the liver edge.At the present time, the patient disease is stable.
Peritoneal carcinomatosis is frequently in the oncologic evolution of patients with colo-rectal cancer, gastric, pancreatic and gynecologic cancers (3).It has been uncommonly reported in prostate cancers (4-6).

Peritoneal carcinomatosis and prostatic cancer: a rare manifestation of the disease with an impact on management
Prostate cancer is uncommonly suggested with CT: this is the role of digital rectal examination, blood test and biopsy, with the contribution of MRI.CT can help to suspect prostate cancer when pelvic lymph nodes or/ and bone lesions are detected (ribs, spine, pelvis and hips).
In our case, peritoneal carcinomatosis was detected during the follow-up in a patient with an abdominal discomfort and abnormal blood tests.We did not have the histological proof of peritoneal carcino matosis but CT was highly suggestive.The final diagnosis of this complication was conclude based on the positive impact of the change of therapy.
As a conclusion, peritoneal carcinomatosis is an uncommon finding in patients with prostate cancer.It can be detected during routine abdominal CT performed during the follow-up of this group of patients.In our institution we have about 50 cases with Y-90 radioembolization.In these cases we embolize gastroduodenal and left gastric arteries.At the fourth week of embolization, we take hepatic angiograms and inject Y-90 substance.These hepatic angiograms indicate a large varia-

Fig. 2 .
Fig. 2. -Abdominal CT performed 9 months after chemotherapy showing disappearance of the ascites and the peritoneal nodules, a part the calcified nodule of the Morison pouch (arrow).