BACKGROUND
This 70-year-old man was found to have adenocarcinoma of the prostate in 1999. At that time, his prostate-specific antigen (PSA) value was 8 ng/dL, and his Gleason score was 8. He was treated with external beam radiation to the prostate.
One year after irradiation, the patient's PSA level started to rise. This biochemical recurrence was treated with complete androgen blockade with goserelin and bicalutamide. Despite treatment, his PSA level continued to rise, reaching 35 ng/dL. The patient was then referred to a urologist, who performed cryotherapy. His PSA value improved from 35 to 25 ng/dL.
The patient began to have severe fatigue and hot flashes due to goserelin. After a full discussion with the urologist, he consented to orchiectomy. Six months later, he began to have pain in his right eye and pain, swelling, and a headache in the right orbital area. The patient was evaluated by an otolaryngologist, who treated him for sinusitis and performed surgery to correct his deviated septum. These treatments provided some relief of his symptoms for a few weeks. However, the patient later felt fullness in his eye and went to an ophthalmologist, who found no retinal or choroids lesion. The patient's visual acuity was normal.
He then went to an oncologist, who ordered diagnostic tests, including orbital CT and bone scanning. What is the diagnosis?
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Hint
Could the problem be associated with the prostate cancer?
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Author:
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Mable W. Tan, MD, Assistant Professor, Department of Geriatrics, University of Oklahoma City, and Winston W. Tan, MD, FACP, Assistant Professor, Department of Hematology Oncology, Mayo Clinic Jacksonville
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eMedicine Editor:
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Sat Sharma, MD
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Associate Professor, University of Manitoba, Department of Medicine, Division of Pulmonary Medicine
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eMedicine Case
