Prostate Cancer Leading Skull Metastasis With Papilledema

A 74-year-old man presented with chronic bilateral blurred vision for 6 months, without ocular pain or redness. Ultra-widefield imaging revealed symmetric papilledema with linear hemorrhages. Head computed tomography showed an expansile, ground‑glass lesion with cortical thinning in the left parieto‑occipital bone, initially suggesting fibrous dysplasia. However, histopathologic and immunohistochemical analysis of the resected bone unexpectedly confirmed skull metastasis from prostate cancer (PCa). Key biochemical markers-notably elevated serum alkaline phosphatase (1320 U/L) and prostate‑specific antigen (100 ng/mL)-had been initially overlooked due to a history of benign prostatic hyperplasia. This case highlights a rare and diagnostically challenging presentation of PCa in an elderly male with papilledema. It underscores the importance of considering metastatic PCa in older men with unexplained papilledema and skull thickening, and emphasizes multidisciplinary collaboration among ophthalmology, neurosurgery, radiology, and oncology to prevent diagnostic delays and improve patient management.