CASE REPORT article
Front. Oncol.
Sec. Genitourinary Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1674548
This article is part of the Research TopicHistological and Molecular Subtypes of Prostate Cancer: Biology, Biomarkers, and Therapeutic ImplicationsView all articles
Unmasking recurrent melena as the initial presentation of metastatic prostate cancer: a case report
Provisionally accepted
- First Affiliated Hospital, Dalian Medical University, Dalian, China
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Background: Prostate cancer, a common malignancy in the male population, is typically characterized by urinary symptoms, such as urinary obstruction and frequency. This report presents a rare case of metastatic prostate cancer that initially manifested with recurrent melena. Case presentation: A 70-year-old man with recurrent melena was admitted to the hospital. Laboratory workups revealed significant pancytopenia, as well as highly elevated serum prostate-specific antigen (PSA) concentrations. However, both upper gastrointestinal endoscopy and colonoscopy found no abnormal bleeding lesions. Further positron emission tomography/computed tomography (PET/CT) examination and pathological results from the bone marrow and prostate gland confirmed the diagnosis of prostate cancer and bone metastasis. After androgen deprivation therapy (goserelin) along with an androgen receptor antagonist (darolutamide), the patient's serum total PSA level declined drastically to 0.01ng/ml, accompanied by an improvement in pancytopenia. During follow-up, he reported significant symptomatic improvement, such as the cessation of melena. Conclusion: When encountering male patients with recurrent melena as the initial presentation, clinicians should be vigilant about the possibility of metastatic prostate cancer. Moreover, a comprehensive evaluation based on multimodality evidence and multidisciplinary management can inform an individualized therapeutic plan for prostate cancer progression.
Keywords: Melena, Metastatic prostate cancer, Initial presentation, Atypical manifestation, Diagnostic challenge, Delayed Diagnosis, case report
Received: 28 Jul 2025; Accepted: 29 Aug 2025.
Copyright: © 2025 Wang, Wang, Sun, Gao, Wei and Duan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhijun Duan, First Affiliated Hospital, Dalian Medical University, Dalian, China
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