PROSTATE ADENOCARCINOMA PRESENTING WITH EXTENSIVE NODAL METASTASIS: A CASE REPORT

Background: Prostate carcinoma typically metastasizes to pelvic and retroperitoneal lymph nodes or bone. Distant nodal involvement, including cervical, axillary, and inguinal nodes, is rare and presents a diagnostic challenge. Case Presentation: We report an 80-year-old male presenting with lower abdominal pain and generalized lymphadenopathy. Laboratory evaluation revealed markedly elevated serum PSA (4412 ng/mL) with normal CEA (2.18 ng/mL). Imaging demonstrated grade II prostatomegaly and extensive lymphadenopathy in pre- and para-aortic regions, pelvic iliac nodes, and the left posterior triangle of the neck; chest imaging was normal. Tru-cut biopsy of the prostate confirmed adenocarcinoma with Gleason score 4+5, and cervical lymph node biopsy showed metastatic adenocarcinoma consistent with prostatic origin. The patient was initiated on docetaxel chemotherapy combined with androgen deprivation therapy (ADT). Conclusion: This case highlights a rare presentation of prostate carcinoma with widespread nodal metastasis and underscores the importance of comprehensive diagnostic evaluation and timely systemic therapy.