Bilateral Endobronchial Prostatic Metastases: A Rare Clinical Entity with Diagnostic and Therapeutic Challenges: A Case Report and Literature Review

Background Endobronchial metastases from prostate cancer are uncommon, representing a diagnostic and therapeutic challenge due to their rarity and variable clinical presentation. Here, we present a case of bilateral endobronchial metastases secondary to adenocarcinoma of the prostate in a 73-year-old male with castration-resistant prostate cancer highlighting the importance of recognizing this rare entity for optimal patient management. Case Presentation The patient is a 73-year-old male with past medical history of atrial fibrillation on anticoagulation alongside a diagnosis of Gleason 3+4 prostate cancer resistant to castration. He presented with shortness of breath and a hemothorax secondary to a CT-guided lung biopsy several days prior, which prompted a pigtail catheter placement. A minimally invasive chest washout was eventually required due to incomplete drainage leading to an incidental discovery of bilateral endobronchial metastases synchronous with lung parenchymal metastasis. Treatment involved endobronchial tumor ablation given chemotherapy ineffectiveness. Discussion and Literature Review Endobronchial metastases from prostate cancer is rare, but must be considered in patients with respiratory symptoms and a history of prostate cancer with pulmonary metastasis. Our literature review reveals a diverse clinical presentation with cough, dyspnea, and hemoptysis being most common. Diagnostic modalities such as bronchoscopy are crucial for accurate diagnosis, allowing for tailored treatment strategies. Hormonal therapy remains the mainstay of treatment, although other modalities such as chemotherapy and bronchoscopic interventions may be considered based on individual patient factors. Conclusions Early recognition of endobronchial metastases secondary to prostate cancer with thorough evaluation, including bronchoscopy, is essential for timely diagnosis and appropriate management.