A 64-year-old male presented with facial dysesthesia and ptosis affecting the left eye and proptosis on the same side in May 2006.
Personal history of hypertension in medical treatment, operated of duodenal ulcus 20 years before, and laryngeal polyposis twice in 1993 and 1994.
Adenocarcinoma pros were diagnosed by ultrasound guided biopsy in September 2005, with PSA of 794, alkaline phosphatases of 870, bone screening showing multiple bone metastases.
At that time, treatment with lh analogues, flutamide, and zoledromic acid 4 mg was started every 21 days for 6 months.
PSA nadir was achieved in January 2006 with values of 36-17 ng/ml.
Days before admission, the patient complained of right facial numbness from the powder to the upper lip, and simultaneously pseudarthrosis of the left eye and protrusion.
She did not complain of diplopia, facial or ocular pain.
In the physical examination, the patient was conscious, cooperative, presenting oriented pseudarthrosis of the left eye with exit of the same side, without apparent murmur, with paresis of the III and VI left pairs.
The patient also presented alterations in the sensitivity of the right half of the face, with the rest of the neurological examination motor and executive normal.
Among the complementary tests in blood stood out GGT 86, alkaline phosphatase 1145, and PSA 121-02.
Brain MRI and NMR angiography showed supratentorial ischemic lesions and an extraconal orbital mass attached to the left orbital roof which caudally displaces and encompasses the superior rectus muscle, at the same time described above.
The superior orbital rim remains intact with no apparent signs of infection.
The obliteration of fat from the upper extraconal fat determines inferior displacement and ocular proptosis.
There is also an expansive mass located in the right maxillary sinus that breaks the lateral wall extending to soft tissues, causing interruption of the floor of the right orbita and invasion of the inferior extraconal space, displacing the rectus muscle.
Signals were free.
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Vertebral computerized axial tomography (CAT) revealed a bony pattern with blastic-lithic alteration and no visceral alterations.
Metastasis of prostatic adenocarcinoma in the right maxillary sinus and left frontal sinus was diagnosed, with right inferior orbital and left superior orbital involvement.
Local radiotherapy was discarded due to the risk of blindness.
Flutamide was withdrawn as treatment, maintaining the lh analogue.
In June 2006, docetaxel 70 mg/m2 was started every 21 days, together with prednisone 10 mg daily.
Six cycles were completed until the end of September 2006.
A PSA nadir was achieved in July 2006 with values of 6-8 ng/ml after the first two administrations of docetaxel.
The patient reported decreased left eye proptosis.
Six cycles were completed with excellent tolerance.
In October 2006, PSA is 149 ng/ml, with no change in MRI images.
Recently, in January 2007, a new treatment with docetaxel and prednisone was restarted.
