Peribronchial cuffing: an underrecognized pattern of prostate carcinoma metastases to the lung.
Peribronchial cuffing is a rare pattern of lung metastasis in advanced prostate cancer that may lead to delays in diagnosis and treatment.
Where it sits
this study against the rest of the degarelix corpusSummary and findings
This study examined the pattern of peribronchial cuffing in patients with advanced prostate cancer. Nine patients were identified with this pattern, with various accompanying clinical and imaging findings. The study aimed to enhance recognition and management of this metastasis type.
Abstract
<h4>Background</h4>Prostate cancer is a leading cause of cancer-related morbidity and mortality in men, with a subset of patients developing aggressive, castrate-resistant disease. We describe an underrecognized pattern of thoracic metastasis - peribronchial cuffing - in patients with advanced prostate cancer, with the aim to elucidate clinical, radiographic, and pathologic features and thus facilitate early recognition and management.<h4>Methods</h4>This was a retrospective case series conducted at a quaternary cancer center between February 2020 and June 2025. Patients with prostate cancer and radiographic evidence of peribronchial cuffing were identified through a multidisciplinary service review. Clinical data were abstracted, radiographic cross-sectional imaging findings were independently confirmed, pathologic specimens were revisited for histochemical staining with H-scoring, and next-generation sequencing results were analyzed.<h4>Results</h4>A total of nine patients demonstrated lower lobe-predominant peribronchial thickening, with 78% exhibiting right-sided involvement. All lesions were FDG- and/or PSMA-avid on positron emission tomography studies. Mediastinal lymphadenopathy and parenchymal lung metastases were concomitantly present in 66 and 22% of patients, respectively. The median time from PSA rise from baseline to cross-sectional imaging was 12.9 months, and from imaging to biopsy was 3.8 months. Tumor TP53 gene alterations were found in 66% of cases. In 33% of patients, the diagnosis of peribranchial metastases resulted in cancer upstaging. On follow-up, 55% of patients died within a median of 5.3 months from radiographic detection.<h4>Conclusions</h4>Peribronchial metastasis represents a rare and underrecognized pattern of advanced prostate cancer spread. Its subtle presentation may result in delays in diagnosis and treatment. Recognition of this pattern in patients with rising PSA can be facilitated by new-generation molecular PET imaging studies to guide earlier biopsy and treatment initiation. Future studies are needed to characterize the pathobiologic mechanisms underlying this form of prostate cancer metastasis.
Background
This paper addresses the clinical recognition of peribronchial cuffing as a pattern of thoracic metastasis in advanced prostate cancer. Prior knowledge indicated that prostate cancer can metastasize to the lungs, but specific patterns like peribronchial cuffing were not well characterized. Understanding this pattern may aid in earlier diagnosis and management of prostate cancer patients.
Methods
This was a retrospective case series conducted at a quaternary cancer center from February 2020 to June 2025. Nine patients with prostate cancer and radiographic evidence of peribronchial cuffing were identified through a multidisciplinary service review. Clinical data were abstracted, imaging findings confirmed, and pathologic specimens analyzed for histochemical staining and next-generation sequencing.
Results
A total of 9 patients demonstrated lower lobe-predominant peribronchial thickening. 66% exhibited mediastinal lymphadenopathy and 22% had parenchymal lung metastases. The median time from PSA rise to imaging was 12.9 months, and from imaging to biopsy was 3.8 months. Tumor TP53 gene alterations were found in 66% of cases. 55% of patients died within a median of 5.3 months from radiographic detection.
Interpretation
The findings suggest that peribronchial cuffing is a significant but underrecognized pattern of metastasis in prostate cancer. While the statistical significance of the findings is noted, the clinical significance may be limited due to the small sample size. The presence of TP53 alterations and the high mortality rate within a short follow-up period raise concerns about the aggressiveness of this metastatic pattern. The study's retrospective nature and small n limit the strength of the conclusions drawn.
Key findings
- 9 patients demonstrated lower lobe-predominant peribronchial thickening.
- 78% exhibited right-sided involvement.
- 66% of patients had concomitant mediastinal lymphadenopathy.
- 22% had parenchymal lung metastases.
- 66% of cases had tumor TP53 gene alterations.
- 55% of patients died within a median of 5.3 months from radiographic detection.
Limitations
- small n=9 case series
- retrospective design limits data reliability
- short follow-up period of 5.3 months
- single-center study may affect generalizability