Paget’s Disease of Bone in Ethnic Thai Presented with
Urologic Symptoms and Misleading as Metastatic Prostate
Cancer: Report of a Case with a Review of the Literature
Supanat Sirikulchayanonta MD*, Suphaneewan Jaovisidha MD**,
Wisoot Kongchareonsombat MD*, Vorachai Sirikulchayanonta MD***
Affiliation :
* Department of Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
** Department of Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
*** Department of Pathology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Paget’s disease of bone is common in some parts of Europe and in countries inhabited by European emigrants.
In Western Countries, Paget’s bone disease is one of the priorities in differential diagnosis for elderly patients who present
osteoblastic lesions, so it is unlikely to be overlooked, even though patients may present symptoms unrelated to bone lesions.
However, in Asian countries where Paget’s disease is rare, metastatic prostate cancer appears to be the most common cause
for osteoblastic lesions, thus, the Paget’s disease is unlikely to be of much concern. This may lead to undue emphasis on
investigations to support the diagnosis of prostate cancer. In this report, a 69 year-old man presented pain in the right leg
and difficulty urinating. The plain film showed osteoblastic lesions of the right pelvic bone and lumbar spine. The pertinent
routine laboratory findings revealed increased levels of serum alkaline phosphatase 125 U/L (normal 27-86). Metastatic
prostate cancer was highly suspected and investigations focused upon this, including a serum prostate specific antigen
assay, a transurethral cystoscopic examination, an intravenous pyelogram, and an ultrasonogram of the prostate gland.
However, all of these investigations failed to support prostate cancer. Bone biopsy was performed twice, resulting in a report
supporting Paget’s disease of bone. The patient was treated with alendronate for three months. Radiologic findings,
six months later, showed signs of improvement. He died one year later of heart failure that could plausibly had been a
cardiovascular complication of Paget’s disease. Better awareness of Paget’s disease in Thailand and other Asian countries
should reduce the incidence of unnecessary investigations and avoid a misleading diagnosis, which could lead to inappropriate
treatment for metastatic prostatic cancer and undesirable psychological impact associated with being misinformed regarding
malignancy.
Keywords : Paget’s disease, Asia, Prostatic cancer, Osteoblastic lesion, Cardiovascular complication
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