A 74-year-old male was admitted for mild left hemiparesis with loss of strength, sensitivity and hyperreflexia.
Cranial Computed Tomography (CT) detected a hyperdense lesion in the right parietal region with multiple blastic lesions in the ribs and dorsal spine on chest CT, all of which were compatible with metastasis.
Cranial Magnetic Nuclear Resonance also detected an intraocular mass in the left eye (LE), hyperintense in T1 and with contrast uptake and hypointense in T2.
The presence of a proband syndrome with a rectal digital rectal examination led to the diagnosis of the primary tumor. Adenocarcinoma was confirmed by prostate biopsy with a Gleason score of 2 + 2.
PSA (prostate specific antigen) was 483 ng/ml.
Examination revealed visual acuity (VA) with optical correction of 0.8 in right eye (OD) and 0.6 in left eye.
The eye fundus of the RE was normal, while in the LE, although the patient was asymptomatic, he had a large grayish intraocular mass, with a small retinal detachment in the temporal sector that occupied.
On ultrasound, the mass appeared with medium echogenicity and considerable measurements of 17 mm of base per 8 mm of height.
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The patient started treatment for advanced prostate carcinoma by maximum androgen deprivation, associating an antiandrogen (bicalutamide) with a LH-RH agonist.
Although there were no changes in VA, choroidal metastasis decreased in size until reaching clinical disappearance within 2 months of treatment initiation.
At the bottom of the eye, a hyperpigmented motto remained in the area of the lesion accompanied by an alteration of the macular pigment epithelium.
The evolution of PSA values was toward a decrease to 31.26 ng/ml at 4 months and to 0.49 ng/ml at 7 months.
Remission of ocular metastases was maintained at 14 months follow-up.
