Bright spine.

The spine is homogeneously osteosclerotic and which appears to have no particular abnormal findings, however, that was proved to be a result of multiple metastases from prostate cancer. We should consider the possibility of prostate cancer if we see a "bright spine" on X-ray examination.

An 86‐year‐old man with benign prostate hypertrophy visited our hospital because of low back pain that had continued for 1 month. X‐ray examination showed that the lumbar spine had homogeneous osteosclerosis (from vertebra T11 to L5), which showed no particular abnormal findings (Figure 1A,B). T1‐ and T2‐weighted magnetic resonance imaging (MRI) revealed degenerative change and multiple low‐intensity lesions in the thoracolumbar spine (Figure 2A,B). Level of prostate‐specific antigen (PSA) was high (>2.5 mg/mL), and he was diagnosed with hormone‐sensitive prostate cancer. Androgen deprivation therapy was started, and the PSA level decreased to 46.5 ng/mL 3 months later.

Figure 1

A, B, Bright spine: homogeneously osteosclerotic and no particular abnormal findings

Figure 2

A,B, Multiple low‐intensity lesions in the spine

Bone metastases originating from prostate cancer frequently occur and may cause severe bone pain and other skeletal‐related events. If diagnosed as bone metastasis from prostate cancer, the patient's risk of death increases by five times.1 The incidence of bone metastasis is ~70% among patients with advanced metastatic disease.2 Early diagnosis is important so as not to worsen the prognosis or quality of life of the patient.

Primary care physicians have many opportunities in daily practice to see patients with bone metastasis of prostate cancer because of its frequency. In primary care settings, there are few facilities that can use advanced diagnostic imaging methods, such as computed tomography or MRI, in addition to X‐ray imaging, so a lot of primary care physicians always make a judgment from X‐ray photographs alone. Primary care physicians should consider the possibility of prostate cancer, not only if they find morphological abnormalities that suggest bone metastasis, but also if they see a “bright spine” on X‐ray examination.

CONFLICT OF INTEREST

The authors have stated explicitly that there are no conflicts of interest in connection with this article.