Toothache as the Leading Clinical Symptom of Metastatic Prostate Adenocarcinoma

Metastatic tumours in the oral region are rare and account for approximately 1% of all malignant oral tumours. Metastatic spread to the oral cavity has mostly been found in the jaws compared to the soft tissues but mandibular metastasis as the first manifestation of undiscovered prostate adenocarcinoma is very rare. We present the case of a 56-year-old man that had teeth extraction in a peripheral hospital following a complaint of toothache. Five months after the teeth extraction, he presented at University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu, with complaints of lower urinary tract symptoms, left jaw pain, left jaw mass, difficulty in opening the mouth, low back pain, lower limb edema, and abdominal distension. After review by the gastroenterology, urology, and maxillofacial teams, the working diagnoses were metastatic prostate cancer, primary jaw tumor, and primary liver cell carcinoma. Abdominal computed tomography (CT) scan was suggestive of metastatic liver disease from an occult site. It also showed metastatic deposits on the right lung and an enlarged prostate with a suspicious focus. Craniofacial CT scan done was suggestive of an aggressive tumour of the left mandible while prostate-specific antigen was 116.5 ng/mL. He had a digitally guided prostate biopsy and an incisional biopsy of the left jaw mass. Histopathologic examination of both specimens was consistent with adenocarcinoma, hence establishing a diagnosis of prostate adenocarcinoma with metastasis to the left jaw, the liver, and the right lung.