Facial nerve palsy as a primary presentation of advanced carcinoma of the prostate: An unusual occurrence

Abstract

Introduction: Cranial nerve neuropathy is a rare presentation of advanced cancer of the prostate.

Observation: We report a case of 65-year-old man who presented with right lower motor neuron (LMN) facial nerve palsy. The prostate had malignant features on digital rectal examination (DRE) and the prostate specific antigen (PSA) was 116 ng/ml. Histology of the prostate biopsy confirmed an adenocarcinoma with the Gleason score of (4 + 3) = 7/10. The computerised tomography (CT) scan of the skull revealed dense osteosclerosis at the base, worse in the petrous part of the right temporal bone with narrowed ipsilateral facial nerve canal. Androgen deprivation therapy (ADT) was achieved by bilateral orchidectomy. Analgesics and bisphosphonates with facial muscles physiotherapy were also administered. He had significant resolution of the facial nerve palsy and the other symptoms at subsequent follow-ups. The related literatures were reviewed.

Conclusion: Facial nerve palsy as a primary presentation of advanced cancer of the prostate is unusual, thus, a high index of suspicion is required to establish the diagnosis. ADT provided adequate palliation.

Keywords: Advanced prostate carcinoma; Facial nerve palsy; Orchidectomy; Palliative treatment; Physiotherapy