Prostate Cancer with a Presenting Symptom of Lower Thoracic Back Pain

Back pain is a common complaint addressed by family physicians. This is an uncommon case of a patient presenting with back pain and subsequent workup revealing a new diagnosis of metastatic prostate cancer with bone metastasis. This case can be used to highlight an unusual presentation and to facilitate inclusion of prostate cancer in the differential diagnosis. A review of the literature calls attention to the clinical features that make such a scenario likely and guides the discussion of the current understanding of the mechanisms leading to such a presentation. Underlying risk factors of obesity, diabetes, and chronic kidney disease (CKD) may increase this risk. A high Gleason score with poorly differentiated features also increases the risk of de novo metastatic presentation.