Chest Pain as a Symptom of Early-Onset Metastatic Prostate Cancer: Exploring the Role of Screening

TL;DR

A 35-year-old man with chest pain was diagnosed with early-onset metastatic prostate cancer, highlighting the need for personalized screening in high-risk individuals.

Contribution

This case emphasizes the importance of considering prostate cancer in young patients with atypical symptoms and a family history of the disease.

Findings

A young patient with chest pain was found to have metastatic prostate cancer with rib lesions.

Genetic testing revealed a BRCA2 mutation, indicating a more aggressive cancer type.

The case underscores the need for tailored screening approaches in high-risk populations.

Abstract

Prostate cancer is one of the most prevalent malignancies affecting males, primarily occurring in older men. However, it has been observed that there is a growing trend of new cases among younger individuals. We present the case of a 35-year-old male who had experienced persistent, severe right-sided chest pain for three months, unrelieved by analgesics. An inpatient workup revealed elevated alkaline phosphatase, prompting a more thorough evaluation that included measuring prostate-specific antigen (PSA) levels. His CT scan revealed sclerotic lesions in the ribs concerning metastatic disease. A biopsy of the enlarged retroperitoneal lymph nodes confirmed the diagnosis of metastatic prostate adenocarcinoma. Due to the patient's age and strong family history, genetic testing was conducted, revealing a BRCA2 mutation. Chest pain in a young patient can be misleading, and his symptoms did not initially suggest prostate cancer as a primary differential diagnosis. However, the persistence of symptoms, imaging results, and a strong family history of prostate cancer directed the physicians toward the correct diagnosis. Additionally, BRCA2 mutations are linked to a more aggressive form of the disease, and a timely diagnosis can lead to better outcomes. However, there is limited data regarding routine screening in high-risk patients such as African Americans and those with genetic predisposition. Therefore, healthcare providers should collaborate with their patients to develop personalized screening plans.

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