Rare case of Prostate Cancer presenting as Oral Swelling: A Report

The case concerns a 76-year-old man, otherwise in good health, who sought dental care for a mobile lower left premolar. Following the tooth's extraction, the site developed a rapidly expanding swelling over two months, prompting further investigation. A CT scan revealed a large destructive lesion in the mandible, leading to a histopathological diagnosis of metastatic prostate adenocarcinoma.

Metastases to the jaw are uncommon and often indicate widespread disease, marking a poor prognosis. Such cases typically present with varied clinical features, including swelling in the oral soft tissues, adjacent subcutaneous areas, or jawbones. These lesions often mimic common dental pathologies, posing diagnostic challenges for dental practitioners. Radiographically, metastatic lesions usually appear as expansive, lytic areas with irregular borders, adding another layer of complexity to early detection.

This case serves as a stark reminder for dental professionals to maintain a high index of suspicion when dealing with unresolved or atypical dental conditions, especially in older patients. Prolonged swelling, gingival or bone lesions unexplained by dental causes, and wounds that fail to heal after extractions are key red flags requiring prompt referral and investigation.

The dentist's role in recognizing oral systemic conditions cannot be overstated. In this instance, the identification of a metastatic lesion in the jaw facilitated timely diagnosis of the underlying prostate cancer. Early detection and referral are crucial in initiating cancer treatment and potentially improving patient outcomes.

As life expectancy increases and the incidence of age-related diseases such as cancer rises, dental practitioners must remain aware of the potential for malignancies to mimic common dental issues. This case underscores the need for continued education and interdisciplinary collaboration to address the diagnostic challenges posed by metastatic diseases presenting in the oral cavity.

The case highlights the importance of thorough clinical examination and the necessity of maintaining a broad differential diagnosis. It serves as a critical reminder that unexplained oral pathologies in older patients could be the first sign of a serious underlying condition.

Reference:

Beaumont, S., Cavanagh, K., Angel, C., & Choong, K. Prostate cancer presenting as an oral swelling—A case report. Australian Dental Journal. https://doi.org/10.1111/adj.13051