{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T06:58:35Z","timestamp":1775026715703,"version":"3.50.1"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Prostate cancer presenting with a clinically suspected inguinal lymph node metastasis (ILNM) is an exceptionally rare and aggressive disease variant. We report a case of a patient with metastatic hormone-sensitive prostate cancer (mHSPC) who presented with an isolated inguinal mass and subsequently developed fatal lymphatic-dominant progression despite standard intensive systemic therapy and an initial deep PSA response. A 68-year-old male patient presented with a painless right groin mass. Imaging and biopsy confirmed high-volume mHSPC (PSA 776.0 ng\/mL, Gleason score 8) with suspected inguinal, pelvic, and bone metastases. Treatment with androgen deprivation therapy (ADT) and abiraterone acetate was initiated, achieving a PSA nadir of &amp;lt;0.090 ng\/mL. Approximately nine months later, he developed refractory lower limb and scrotal edema, bilateral hydronephrosis, and renal impairment. Despite comprehensive supportive care including ureteral stenting, his condition deteriorated rapidly, resulting in death. This case highlights a rare clinical scenario of lymphatic-dominant progression occurring despite excellent systemic biochemical control. It underscores the need for vigilant monitoring of regional lymphatic complications and early multidisciplinary intervention in high-risk mHSPC patients presenting with non-typical metastases.<\/jats:p>","DOI":"10.3389\/fonc.2026.1751798","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:02:31Z","timestamp":1775019751000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Fatal lymphatic-dominant progression in metastatic prostate cancer initially presenting with a clinically suspected inguinal node metastasis: a case report"],"prefix":"10.3389","volume":"16","author":[{"given":"Jian","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Urology, Zigong First People\u2019s Hospital","place":["Zigong, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yonglin","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Urology, Rongxian People\u2019s Hospital","place":["Zigong, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bin","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University","place":["Chengdu, Sichuan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA: Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2010.02.317","article-title":"258 population-based evaluation of changes in urinary symptoms and bother after a diagnosis of prostate cancer","author":"Tollefson","year":"2010","journal-title":"J Urol - 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a report of three cases with literature review","volume":"17","author":"Dattani","year":"2022","journal-title":"Radiol Case Rep"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.5173\/ceju.2012.02.art11","article-title":"A case of metastatic prostate adenocarcinoma to an inguinal lymph node","volume":"65","author":"Komeya","year":"2012","journal-title":"Cent Eur J Urol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2015-210825","article-title":"Prostatic adenocarcinoma presenting as isolated inguinal lymphadenopathy","volume":"2015","author":"Doreswamy","year":"2015","journal-title":"BMJ Case Rep"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.euo.2020.07.001","article-title":"Patterns of cancer progression of metastatic hormone-sensitive prostate cancer in the ECOG3805 CHAARTED trial","volume":"3","author":"Bryce","year":"2020","journal-title":"Eur Urol Oncol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.euo.2024.04.009","article-title":"Radiographic progression without corresponding prostate-specific antigen progression in patients with metastatic castration-sensitive prostate cancer receiving apalutamide: secondary analysis of the TITAN trial","volume":"8","author":"Fukuokaya","year":"2025","journal-title":"Eur Urol Oncol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2022.40.16_suppl.5072","article-title":"Radiographic progression in the absence of prostate-specific antigen (PSA) progression in patients with metastatic hormone-sensitive prostate cancer (mHSPC): Post hoc analysis of ARCHES","volume":"40","author":"Armstrong","year":"","journal-title":"J Clin Oncol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1038\/onc.2011.199","article-title":"EPLIN downregulation promotes epithelial-mesenchymal transition in prostate cancer cells and correlates with clinical lymph node metastasis","volume":"30","author":"Zhang","year":"2011","journal-title":"Oncogene"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1111\/cas.13586","article-title":"Tumor necrosis factor-\u03b1 induces prostate cancer cell migration in lymphatic metastasis through CCR7 upregulation","volume":"109","author":"Maolake","year":"2018","journal-title":"Cancer Sci"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1002\/pros.24791","article-title":"Evaluating RB1 and p53 as diagnostic markers in treatment-related neuroendocrine prostate cancer through immunohistochemistry and genomic analysis of RB1 and TP53","volume":"84","author":"Ueki","year":"2024","journal-title":"Prostate"},{"key":"B18","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1126\/science.aah4199","article-title":"Rb1 and Trp53 cooperate to suppress prostate cancer lineage plasticity, metastasis, and antiandrogen resistance","volume":"355","author":"Ku","year":"2017","journal-title":"Sci (New York NY)"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1200\/jco-24-01798","article-title":"Darolutamide in combination with androgen-deprivation therapy in patients with metastatic hormone-sensitive prostate cancer from the phase III ARANOTE trial","volume":"42","author":"Saad","year":"2024","journal-title":"J Clin Oncol Off J Am Soc Clin Oncol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(22)00367-1","article-title":"Abiraterone plus prednisone added to androgen deprivation therapy and docetaxel in de novo metastatic castration-sensitive prostate cancer (PEACE-1): a multicentre, open-label, randomised, phase 3 study with a 2\u2009\u00d7\u20092 factorial design","volume":"399","author":"Fizazi","year":"2022","journal-title":"Lancet"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1751798\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:02:35Z","timestamp":1775019755000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1751798\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":20,"alternative-id":["10.3389\/fonc.2026.1751798"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1751798","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]},"article-number":"1751798"}}