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Bone Marrow Metastatic Prostate Cancer Representing Itself With Deep Anemia

Introduction Prostate cancer (PCa) is the second leading cancer in both sexes and the most common cancer in males. Prostate cancer preferentially spreads to regional lymph nodes and bone. Significant metastases to lung, liver or other visceral organs are less common [1]. Patients have a good survival rate if the cancer is diagnosed at an early stage [2]. Generally the patients contact the doctors when the malignancy almost spread in other parts of the body. This is an advanced stage of cancer which is called Metastatic disease. At this stage is incurable and causes significant mortality. Symptoms of advanced prostate cancer are bone pain, spinal cord compression, fatigue, depression, obstruction, weight loss, constipation and anaemia.


Introduction
Prostate cancer (PCa) is the second leading cancer in both sexes and the most common cancer in males. Prostate cancer preferentially spreads to regional lymph nodes and bone. Significant metastases to lung, liver or other visceral organs are less common [1]. Patients have a good survival rate if the cancer is diagnosed at an early stage [2]. Generally the patients contact the doctors when the malignancy almost spread in other parts of the body. This is an advanced stage of cancer which is called Metastatic disease. At this stage is incurable and causes significant mortality. Symptoms of advanced prostate cancer are bone pain, spinal cord compression, fatigue, depression, obstruction, weight loss, constipation and anaemia.

Case Report
A 70-year-old male patient admitted to physiotherapy doctor with complaint of intermittent lower back pain lasting 2 months. Routine tests related to lower back pain such as hemogram, C-Reactive Protein (CRP), sedimentation rate and lumbosacral radiography were requested. The test results were as follows haemoglobin 7.7 g/dl, hematocrit 23.5%, platelets 132 000 /mm 3 , white blood cell 4500/mm 3

Discussion
The United States Preventive Services Task Force (USPSTF) has advised against the use of PSA for screening purposes [3]. Nevertheless, with declining rates of PSA testing, there has been an increased incidence of metastatic prostate cancer in the United States. The incidence of low-risk prostate cancer decreased from years 2007 to 2013 to 37% less than that of 2004. Conversely, the incidence of metastatic prostate cancer increased to 72% between 2007-2013 more than that of 2004. The greatest increase in metastatic prostate cancer was seen in men aged 55-69 years.
Patients at these ages thought to most benefit from prostate cancer screening and early definitive treatment [4]. We can recognize patients with prostate cancer owing to PSA screening in the early stages and we can treat them.
Nevertheless, patients with no urological complaints and patients who did not admit to the urology before or did not have PSA screening can be presented with advanced disease.
Bone involvement by solid tumours can be diagnosed on CT, MRI or bone scan. It is very rare to detect nonhematologic malignancy while examining the bone marrow biopsy. Detection of bone marrow metastatic deposits is important to determine the stage of the malignancy, chemotherapeutic response, prognosis and follow up [5].
Hypercalcemia, bone pain, raised the level of ALP and LDH, unexplained cytopenias and lytic or sclerotic bony lesions on radiology suggest bone marrow metastasis.

Conclusion
Declining use of the PSA test has been associated with an increased incidence of metastatic prostate cancer. Prostate cancer is a slowly developing malignancy but untreated cases can present symptoms of advanced disease such as

Conflicting Interests
The Author(s) declare(s) that there is no conflict of interest.

Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Informed Consent
Written informed consent was obtained from the patient(s) for their anonymized information to be published in this article.

Ethical Approval
Our institution does not require ethical approval for reporting individual cases or case series.

Contributorship
AY wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript