prostate cancer is the sixth most frequent cancer in the world ( in the number of new cases ) , the third most common cancer in men , and the most frequent cancer in men in europe , north america , and some parts of africa . the most general sites of prostate cancer distant metastasis are bones , regional lymph nodes , lung , liver , brain , and the epidural space . however , metastasis from prostate cancer is an extremely unusual situation with a reported rate of 0.4% to 1% of cases . we report two prostate cancer cases that presented with a supraclavicular bulky mass as the initial and the most bothersome symptom . a 78-year - old male who attended the emergency department with a bulky left supraclavicular mass was consulted because of lower urinary tract symptoms . physical examination revealed a solid , multilobulated mass in the left supraclavicular region , measuring 9 cm at its longest diameter . he reported weight loss of 15 kg over the previous four months and symptoms related to lower urinary tract obstruction for five months . laboratory investigations in terms of whole blood count , blood chemistry and urinalysis were all in the normal ranges . digital rectal examination ( dre ) revealed a hard , irregular prostate with a volume of 58 cc in transrectal ultrasonography ( tru ) . serum prostate - specific antigen ( psa ) level was 171.0 ng / ml . bone scintigraphic examination revealed a metastatic lesion at the fifth lumbar vertebra . histological examination revealed a lymph node widely replaced by metastatic adenocarcinoma staining positive for psa and prostate - specific acid phosphatase consistent with metastatic adenocarcinoma of the prostate ( fig . therefore , twelve quadrant fine needle biopsies were performed under tru guidance which revealed a prostate cancer with a gleason score of 8/10 . he was started on cyproterone acetate , 100 mg , three times a day and leuprorelin acetate injections , 3.75 mg , monthly . ten months later , the patient had significant symptomatic relief with a marked reduction in supraclavicular lymphadenopathy and a decreased prostate - specific antigen level of 12.1 ng / ml . a 65-year - old male patient was admitted to the oncology outpatient clinic with complaints of left supraclavicular lymphadenopathy . laboratory investigations in terms of whole blood count , blood chemistry and urinalysis were all in the normal ranges . digital rectal examination ( dre ) revealed a hard , irregular prostate with a volume of 64 cc in transrectal ultrasonography ( tru ) . serum prostate - specific antigen ( psa ) level was > 1500 ng / ml . serum free psa level was > 25 ng / ml . bone scintigraphic examination revealed multiple vertebral metastatic lesions . histological examination revealed a metastatic adenocarcinoma staining positive for psa and prostate - specific acid phosphatase consistent with metastatic adenocarcinoma of the prostate . prostate cancer is the most frequent cancer and the second leading cause of cancer death in men . dissemination of prostate cancer into the adjacent organs ( urethra , bladder neck and seminal vesicles ) is rare . prostate carcinoma is known to invade by way of three mechanisms : local , haematogenous spreading , and lymphatic metastasis . lymphatic spreading occurs most often in regional lymph nodes such as the obturator , internal and external iliac lymph nodes , presacral and para - aortic lymph nodes . distant superficial lymphadenopathy is a rare symptom on initial presentation in prostate cancer . in terms of a supraclavicular mass discovered during physical examination , most frequently nasopharynx , oral cavity and upper gastrointestinal tract cancer metastases to cervical and supraclavicular lymph nodes are observed [ 911 ] . noted that , in 35 patients with non - regional lymphatic invasion from prostate carcinoma , the left supraclavicular fossa was the most common location of metastasis in 69% of cases . butler et al . published 19 patients with prostate cancer presenting at first with supraclavicular lymphadenopathy , in which the diagnosis was verified by prostate biopsy in 14 patients . a psa performed a few days after admission was 326 ng / ml and a fine needle biopsy of the lymphadenopathy confirmed a prostate cancer metastasis . cho et al . reported 26 cases of metastatic prostate cancer in supradiaphragmatic lymph nodes , in which only 7 cases had a history of prostate cancer ; they noted that 58% had an abnormal rectal examination . although prostate cancer is widespread , the prostate is often overlooked as the first site for men presenting with supraclavicular lymph node metastases . fine needle aspiration biopsy of supraclavicular lymph nodes may be useful for pathological diagnosis of prostate cancer metastasis . in our patients , serum psa level and immunohistochemical staining for psa in biopsy material were used in detection of the primary location of the cancer . two patients had highly elevated serum psa levels , and bone scintigraphic examination revealed metastatic lesions . it should always be kept in mind that prostate cancer is the most frequent cancer in elderly men , and although very unusual , the presenting finding can be a cervical or supraclavicular lymphadenopathy ; thus clinicians should be aware of urological examinations of such cases .
clinical examination is very important in the practice of medicine . in patients presenting with a supraclavicular mass , 
 a number of diseases including cancer should be ruled out . 
 two patients who presented with a bulky left supraclavicular mass were evaluated . 
 their medical history revealed complaints attributed to lower urinary tract infection . 
 we performed histopathological examination of the lymph nodes with radiological evaluation of the thorax and abdomen . 
 the final diagnoses were prostate cancer in both patients . 
 it should always be kept in mind that prostate cancer is the most frequent cancer in elderly men , and although very unusual , the presenting finding can be cervical or supraclavicular lymphadenopathy ; thus clinicians should be aware of urological examinations in such cases .