# Prostate cancer inducing secondary linitis plastica of the rectum: a rare case report and literature review

## TL;DR

An 82-year-old man with prostate cancer developed rare secondary rectal linitis plastica, diagnosed through imaging, endoscopy, and biopsy, and successfully treated with a multidisciplinary approach.

## Contribution

This case report highlights the rare presentation of prostate cancer as secondary rectal linitis plastica and emphasizes the importance of multidisciplinary diagnosis.

## Key findings

- Prostate cancer can present as secondary rectal linitis plastica with elevated PSA and rectal thickening.
- Combination therapy reduced PSA levels significantly within 8 months.
- Diagnosis requires multi-modality imaging, endoscopy, and histopathological biopsy.

## Abstract

Prostate cancer, the most prevalent male malignancy in Western countries, seldom presents as secondary rectal linitis plastica (RLP).

We present an 82-year-old man with a 6-month history of altered bowel habits, narrowed stools, and mucous discharge, with absent lower urinary tract symptoms. Serum Prostate Specific Antigen (PSA) was markedly elevated (392 ng/mL). Imaging demonstrated circumferential rectal thickening and a prostatic mass invading the bladder. MRI revealed a “target sign” with associated diffusion restriction. Colonoscopy identified circumferential mucosal protrusions resembling grape-like clusters (Nice Band Imaging (NBI) International Colorectal Endoscopic (NICE) type 3). Deep biopsies confirmed prostatic adenocarcinoma (Gleason score 4 + 3 = 7).

A multidisciplinary team confirmed the diagnosis of prostate cancer with secondary RLP.

Combination therapy (prophylactic colostomy, leuprorelin, and abiraterone) reduced PSA from 392 to 2.16 ng/mL within 8 months.

RLP may mimic various gastrointestinal disorders clinically. Clinicians should consider RLP in elderly men presenting with gastrointestinal symptoms. Definitive diagnosis requires the integration of multi-modality imaging, endoscopy, and histopathological biopsy.