Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Hypercalcemia in Advanced Prostatic Carcinoma: A Rare Event

Mary Mathews*, Abhishek Kumar, Nelly Awkar, Deepak Dhaliwal, Michael Maroules

Department of Internal Medicine, St. Joseph’s Regional Medical Center, New York Medical College

Abstract: Prostate cancer is typically associated with metastatic osteoblastic lesions, hypocalcemia and hypophosphatemia. Hypercalcemia is a rarely encountered phenomenon i.e. 1-2% in prostate cancer, although it is well associated with other malignant cancers involving breast, lung, head, neck and multiple myelomas. We present the case of a 63 year old Mexican man with history of advanced prostatic adenocarcinoma and trans-urethral resection of prostate presented to ER with nausea, vomiting, polydipsia and altered mental status. Clinically, he appeared dehydrated and pale, with no other remarkable findings. Laboratory findings indicated severe hypercalcemia with calcium-16.1 mg/dL, with imaging studies revealing extensive metastatic osteoblastic lesions. Our patient was treated with aggressive hydration, calcitonin and pamidronic acid, his clinical status improved with complete resolution of hypercalcemia. We have discussed the possible underlying mechanisms and their interplay involved in the presentation of hypercalcemia in prostate cancer, and that its occurence is unlikely due to skeletal metastases.

Keywords: prostate cancer, hypercalcemia, skeletal metastasis, osteoblastic lesions

Received January 09, 2015; Revised January 24, 2015; Accepted January 29, 2015

Citation: Mary Mathews, Abhishek Kumar, Nelly Awkar, Deepak Dhaliwal, Michael Maroules, Hypercalcemia in Advanced Prostatic Carcinoma: A Rare Event. American Journal of Medical Case Reports, 3 (3). 64-65. January 2015. doi:10.12691/ajmcr-3-3-3

1. Case Report

A 63 year old Mexican man with history of advanced prostatic adenocarcinoma and trans-urethral resection of prostate presented to ER with nausea, vomiting, polydipsia and altered mental status. The patient had previously received multiple lines of therapies including leuprolide, pelvic radiation therapy, docetaxel, cabazitaxel and abiraterone. He was medically castrated secondary to leuprolide therapy, with a testosterone level level 1.20 ng/dL. Clinically, he appeared dehydrated and pale, with no other remarkable findings. Laboratory findings indicated severe hypercalcemia with calcium-16.1 mg/dL, serum alkaline phosphatase -251 IU/L, PSA>149 ng/mL, hemoglobin-7.6 g/dL and platelets-61,000, BUN-30 mg/dL and creatinine-2.44 mg/dL, intact parathyroid hormone(PTH) of 10.5 PG/mL and PTH related peptide (PTHrp) of 0.74 pmol/L (normal<2.0 pmol/L).Despite the presence of severe hypercalcemia, he did not develop any cardiac arrythmias. He underwent a PET scan (Figure 1A) and bone scan (Figure 1B) revealing extensive metastatic osteoblastic lesions. His bone marrow biopsy was indicative of metastatic carcinoma of prostatic origin, resulting in severe anemia and thrombocytopenia. The patient was treated with aggressive hydration, calcitonin and pamidronic acid. The patient’s mental status improved with resolving hypercalcemia and kidney functions, he was discharged on enzalutamide, leuprolide and zometa. Our patient had followed up two weeks after discharge, his improvement in clinical status was maintained and there was complete resolution of the hypercalcemia with calcium of 9.5 mg/dL.

Figure 1. PET scan (A) and Bone scan (B), demonstrating extensive metastaic osteoblastic lesions

2. Discussion

Prostate cancer is typically associated with metastatic osteoblastic lesions, hypocalcemia and hypophosphatemia. [1,2,3] Hypercalcemia is rarely encountered in prostate cancer, although it is well associated with other malignant cancers involving breast, lung, head, neck and multiple myelomas. [1,2] Despite affinity of prostate cancer towards skeletal metastases, only 1-2% of patients present with hypercalcemia. [3,5,6] Hypercalcemia may indicate a tumor recurrence or a preterminal event, including increased risk of detrimental skeletal events and death. [1,3] Many different mechanisms of malignancy associated hypercalcemia have been proposed, such as humoral mechanisms (PTH or PTH like peptides, prostaglandins etc.), direct-release mechanism (osteolytic stimulation via neoplastic cells), epidermal growth factors (EGF), transforming growth factors (TGF) and lastly inherent tumor mosaicism. [3,4] Laboratory results on our patient ruled out hyperparathyroidism and PTHrp related hypercalcemia. Our Imaging studies indicated a osteoblastic nature of lesions favoring a positive calcium balance, suggesting a different underlying pathophysiology of mineral metabolism in these patients [1,4].

We postulate that the presence of hypercalcemia is unlikely solely due to skeletal metastases in our patient, but is the interplay of osteoclastic bone resorption via EGF, TGF and underlying tumor mosaicism.

In conclusion, we believe that independent and synergistic roles between direct stimulation of osteoclastic activity (via neoplastic cells), growth factors (like EGF, TGF) as well as underlying tumor mosaicism should be considered by physicians in patients presenting with unexplained hypercalcemia in prostatic carcinoma, it is not merely an extension of skeletal metastases.

References

[1]   | Tucci, M., et al. Prognostic significance of disordered calcium metabolism in hormone-refractory prostate cancer patients with metastatic bone disease. Prostate cancer and prostatic diseases. 2008; 12 (1):94-99.
[2]   | Raskin, Philip, Craig J. McClain, and Thomas A. Medsger. Hypocalcemia associated with metastatic bone disease: a retrospective study. Archives of internal medicine. 1973; 132(4): 539-543.
[3]   | Avashia, Jay H., et al. Metastatic carcinoma of the prostate with hypercalcemia. Cleveland Clinic journal of medicine. 1990; 57. 7: 636-638.
[4]   | Olsson, Arne M., and Gösta Jönsson. Advanced cancer of the prostate combined with hypercalcaemia. Scandinavian journal of urology and nephrology. 1977; 11(3): 293-296.
[5]   | Wu, Ching-Heng, et al. Hypercalcemia in prostate cancer with positive neuron-specific enolase stain. Renal failure. 2004; 26(3): 325-327.
[6]   | Mahadevia, Panna S., et al. Hypercalcemia in prostatic carcinoma: report of eight cases. Archives of internal medicine. 1983; 143(7): 1339-1342.