Metastatic Prostate Cancer Presenting With Bilateral Inguinal Lymphadenopathy

The most common sites of metastasis in prostate cancer are bones and regional lymph nodes, followed by lung, liver, or brain. Lymphatic spread mostly occurs in regional lymph nodes such as the obturator and internal and external iliac lymph nodes, followed by presacral and para-aortic lymph nodes, with supradiaphragmatic lymph node involvement being rare. Inguinal lymph node metastasis with prostate cancer is very rare. Most reported cases occur in patients with recurrent or advanced disease. Few cases have been reported of inguinal lymphadenopathy at early presentation of metastatic disease. We report a case of 53-year-old man who presented with bilateral inguinal lymphadenopathy. Clinical examination, imaging, and biopsy revealed prostate cancer (Gleason 4 thorn 5) with bone metastasis and inguinal lymph node metastasis without pelvic lymph node involvement. This atypical rare presentation of prostate cancer emphasizes the importance of considering metastatic prostate cancer in the differential diagnosis for generalized or inguinal lymphadenopathy.