Cystic and cavitating lung lesions as a presenting finding of metastatic prostate cancer

A 56‐year‐old man presented with cough, dyspnoea and urinary symptoms. He was prescribed antibiotics and, when the symptoms did not improve, a computed tomography (CT) scan was ordered. The CT scan showed innumerable cavitating, cystic and solid lesions throughout both lungs, predominantly affecting the upper zones (Figure, A and B). Differential diagnosis for multiple cavitating and cystic lung lesions includes malignant, infective, vascular and inflammatory causes. Pulmonary metastases can occur secondary to a variety of primary cancers; cavitation may be suggestive of squamous cell carcinomas or less commonly sarcomas or adenocarcinomas.1

Bone scan showed metastatic disease. Prostate‐specific antigen (PSA) blood test result was elevated to 199 µg/L (reference interval, 0.3–4.0 µg/L). Core biopsies of a lung lesion revealed metastatic prostate adenocarcinoma.

The patient started androgen deprivation therapy and received standard of care treatment with six cycles of docetaxel chemotherapy,2 with a reduction in PSA to 0.05 µg/L and a marked improvement in the multiple pulmonary lesions on CT scan (Figure, C and D).