Peribronchial cuffing: an underrecognized pattern of prostate carcinoma metastases to the lung

BACKGROUND: Prostate cancer is a leading cause of cancer-related morbidity and mortality in men, with a subset of patients developing aggressive, castrate-resistant disease. We describe an underrecognized pattern of thoracic metastasis - peribronchial cuffing - in patients with advanced prostate cancer, with the aim to elucidate clinical, radiographic, and pathologic features and thus facilitate early recognition and management. METHODS: This was a retrospective case series conducted at a quaternary cancer center between February 2020 and June 2025. Patients with prostate cancer and radiographic evidence of peribronchial cuffing were identified through a multidisciplinary service review. Clinical data were abstracted, radiographic cross-sectional imaging findings were independently confirmed, pathologic specimens were revisited for histochemical staining with H-scoring, and next-generation sequencing results were analyzed. RESULTS: A total of nine patients demonstrated lower lobe-predominant peribronchial thickening, with 78% exhibiting right-sided involvement. All lesions were FDG- and/or PSMA-avid on positron emission tomography studies. Mediastinal lymphadenopathy and parenchymal lung metastases were concomitantly present in 66 and 22% of patients, respectively. The median time from PSA rise from baseline to cross-sectional imaging was 12.9 months, and from imaging to biopsy was 3.8 months. Tumor TP53 gene alterations were found in 66% of cases. In 33% of patients, the diagnosis of peribranchial metastases resulted in cancer upstaging. On follow-up, 55% of patients died within a median of 5.3 months from radiographic detection. CONCLUSIONS: Peribronchial metastasis represents a rare and underrecognized pattern of advanced prostate cancer spread. Its subtle presentation may result in delays in diagnosis and treatment. Recognition of this pattern in patients with rising PSA can be facilitated by new-generation molecular PET imaging studies to guide earlier biopsy and treatment initiation. Future studies are needed to characterize the pathobiologic mechanisms underlying this form of prostate cancer metastasis.