Metastatic prostate cancer masquerading clinically and radiologically as a primary caecal carcinoma

A 72 year-old man presented with abdominal discomfort and a clinically palpable caecal mass and a firm nodule on his thigh, the latter behaving clinically and radiologically as a lipoma. Computed tomographic (CT) scan showed a luminally protuberant caecal mass with regional nodal involvement. The patient was being treated (Zoladex？) for prostatic cancer diagnosed 6 years previously and was known to have bony metastases. On admission his PSA was 245.4 nmol/ml. The patient underwent a right hemicolectomy. Histology showed a poorly differentiated adenocarcinoma which was PSA positive, confirming metastatic prostatic adenocarcinoma to the caecum. The patient underwent adjuvant chemotherapy and is free from recurrence a year later.Metastasis of prostatic carcinoma to the bowel is a very rare occurrence and presents a challenging diagnosis. The diagnosis is supported by immunohistochemistry for PSA. The treatment for metastatic prostate cancer is mainly palliative.Prostatic carcinoma is the second most common cause of cancer related deaths in males in the West [1]. Approximately 20% of patients present with metastatic disease but colo-rectal involvement is rare[2]. We describe the case of a patient with metastatic prostate cancer to the bowel presenting as primary caecal cancer.A 72-year-old man presented with abdominal discomfort with small amount of bleeding per rectum and a clinically palpable lump in the right iliac fossa. He also had a large, firm, mobile lump on his left thigh.He had been treated six years previously for prostatic carcinoma which was Gleason's grade 3+3= 6. Bony metastases had been diagnosed recently. He was on Zoladex？ injections.Clinical examination showed a 6 cm hard, mobile, non-tender mass in his right iliac fossa. Digital rectal examination was unremarkable. Rigid sigmoidoscopy revealed radiation proctitis, which would explain his bleeding per rectum. CT scan of abdomen showed a caecal tumour with regional lymphadenopathy and vertebral metasta