the most common metastatic site of metastases in patients with prostate cancer is the axial skeleton and local lymph nodes . rarely has there been a description of metastatic prostate cancer to the stomach , esophagus , small bowel , and rectum . we report an unusual case of a patient who was diagnosed with prostate cancer with synchronous metastasis to both the stomach and sigmoid colon . a 71-year - old african american man with a history of prostate cancer was admitted with a hemoglobin level of 6.1 g / dl , which had decreased from the baseline value of 8 g / dl . he underwent an esophagogastroduodenoscopy , which revealed a nodule in the fundus of stomach ; a biopsy of the nodule was done . to the best of our knowledge , this is the first case report in literature of synchronous metastasis of prostate cancer to both the stomach and sigmoid colon . prostate cancer is the leading cancer diagnosis in males , with an estimated incidence of 241,740 in 2012 and total deaths estimated to be 28,170 in 2012 . most common locations of metastases of prostate cancer are the axial skeleton and local lymph nodes . there are cases in the medical literature that describe prostate cancer metastasizing to the lungs , liver , and adrenals . there are very few case reports of metastasis of prostate cancer to the gastrointestinal system . this is , to our knowledge , the first case report of a patient with synchronous metastasis of prostate adenocarcinoma to the stomach and colon . a 71-year - old african american man with a medical history significant for hypertension , prostate cancer treated with surgery and radiation therapy over 10 years ago , diabetes mellitus , and a bilateral knee arthroplasty for severe degenerative arthritis was admitted with complaints of weakness and dizziness . he denied any symptoms of nausea , vomiting , abdominal pain , melena , changes in bowel habit , bright red blood per rectum , or hematuria . physical examination revealed a thinly built male in no acute distress with pale conjunctiva , otherwise essentially unremarkable . vitals signs showed a temperature of 97.8 , pulse 86 , blood pressure 147/88 mm / hg , and respiratory rate 16 . laboratory data revealed hemoglobin of 6.1gm / dl , hematocrit of 18.3% , platelet count of 196,000/l , white blood cell ( wbc ) count of 4,000/l , mean corpuscular volume of 80  , red cell distribution width of 21.6% , reticulocyte count of 2.1% , blood urea nitrogen ( bun ) of 12 mg / dl , creatinine of 0.75 mg / dl , prothrombin time of 15 sec , international normalized ratio of 1.2 , activated partial thromboplastin time activated partial thromboplastin time ( aptt ) of 38.7 sec , and prostate - specific antigen ( psa ) of > 150 ng / ml . iron studies revealed serum iron level of 68 g / dl , ferritin of 1,500 ng / dl , iron binding capacity of 157 g / dl , and an iron saturation of 43% . the patient 's previous laboratory data revealed hemoglobin of 8.0 gm / dl and hematocrit of 24.6% . the patient was transfused three units of packed red blood cells ; furthermore , gastroenterology was consulted to rule out gastrointestinal loss as the etiology of the patient 's anemia . egd [ figure 1a ] revealed a 5-mm nodule in the fundus and a 5-mm clean - based ulcer in the body of the stomach ; multiple erosions were found in the antrum . biopsies were taken from the fundus nodule , gastric body ulcer , and antrum and sent for pathology . colonoscopy [ figure 1b ] revealed diminutive sessile polyps in the cecum , sigmoid colon , and rectum , in addition to large internal hemorrhoids . biopsy results from the antrum and body ulcer showed minimal inflammatory cell infiltration , and the stains for helicobacter pylori were negative . however , the pathology studies of the sigmoid polyp and fundus nodule [ figure 2a and b ] were consistent with adenocarcinoma , and special immunohistochemical staining [ figure 2c and d ] confirmed that it was consistent with prostatic origin . the patient was subsequently started on antiandrogen ( bicalutamide 50 mg / day p.o . ) and leuprolide acetate [ luteinizing hormone - releasing hormone ( lhrh ) agonist ] . the patient has remained hemodynamically and clinically stable for 6 months since the diagnosis of synchronous metastasis of prostate cancer to the stomach and colon . ( a ) endoscopic images of the gastric nodule in the fundus of the stomach . ( b ) endoscopic images of rectosigmoid polyp , which was removed and sent for pathologic evaluation ( a ) hematoxylin - eosin staining at intermediate magnifications shows neoplastic cells occupying the gastric mucosa in diffuse and nested arrangements . ( b ) neoplastic cells in the fundic gastric mucosa demonstrating psa immunohistochemical staining at low magnifications . ( c ) hematoxylin - eosin staining at intermediate magnifications shows neoplastic cells occupying the colonic mucosa in diffuse and nested arrangements . only five cases have been described in the medical literature with gastric metastases from prostate cancer . gastric metastasis has been reported infrequently in the past , with an incidence of 1 - 4% in five postmortem studies . all cases initially presented with isolated gastric involvement , but only one case presented with rectal infiltration with prostate adenocarcinoma . various proposed routes include hematogenous cava - type spread with and without lung involvement , lymphatic spread , or direct infiltration . predominant tumor sites for metastases , such as the lungs or liver , have rich capillary vessels and , hence , a constant blood flow which may explain the pathophysiology of tumor spread ; however , metastasis to the gastrointestinal tract may most likely occur via the lymphatic route because the prostate has a rich lymphatic drainage . as with other reported cases of gastric metastasis , our patient did not have symptoms of nausea and vomiting . our patient presented clinically with symptomatic anemia and that prompted an upper endoscopic evaluation to identify a gastrointestinal source of bleeding . green demonstrated that the most common initial symptoms or findings for gastric metastasis from solid tumors were diffuse abdominal pain , nausea and vomiting , anorexia , guaiac - positive stool , and gastrointestinal bleeding . on histopathology , prostatic adenocarcinoma classically demonstrates the relative lack of nuclear anaplasia , with nuclear uniformity , paucity of mitotic figures , and the absence of signet - ring cell forms . the diagnosis is confirmed by immunohistochemical staining with a positive psa stain and a negative mucicarmine stain . a majority of previous cases that describe the metastasis of prostate cancer to the gastrointestinal tract were , unlike our patient , hormone - refractory and were managed with chemotherapy . in hormone - sensitive cases , similar to our case , this treatment approach has resulted in a decrease in psa levels and clinical stability of the disease . this is the first report in the literature of synchronous metastasis to both stomach and sigmoid colon from prostate cancer . although a very rare disease entity , it is imperative for oncologists , gastroenterologists , and urologists to consider the possibility of prostate carcinoma metastasizing to the gastrointestinal tract in a patient presenting with gastrointestinal symptoms and a history of prostatic adenocarcinoma .
context : prostate cancer is the leading cancer diagnosis in males . the most common metastatic site of metastases in patients with prostate cancer is the axial skeleton and local lymph nodes . rarely has there been a description of metastatic prostate cancer to the stomach , esophagus , small bowel , and rectum.case report : we report an unusual case of a patient who was diagnosed with prostate cancer with synchronous metastasis to both the stomach and sigmoid colon . 
 a 71-year - old african american man with a history of prostate cancer was admitted with a hemoglobin level of 6.1 g / dl , which had decreased from the baseline value of 8 g / dl . 
 he underwent an esophagogastroduodenoscopy , which revealed a nodule in the fundus of stomach ; a biopsy of the nodule was done . 
 the patient also underwent a sigmoid polypectomy . 
 both surgical specimens were histopathologically consistent with metastatic adenocarcinoma of prostatic origin.conclusion:to the best of our knowledge , this is the first case report in literature of synchronous metastasis of prostate cancer to both the stomach and sigmoid colon .