Prostate Cancer Metastasis to Stomach: A Case Report and Review of Literature

Round 1

Reviewer 1 Report

It is true that this article is a review article, but it is necessary and important to provide preliminary explanations about the topic of the article, so the authors should provide more comprehensive explanations about prostate cancer and its possible metastases to different organs in the "introduction section" and then to "Prostate Cancer Metastasis to Stomach".

Author Response

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Reviewer 2 Report

It is worthwhile to document the rare gastric metastases of prostate cancer for the patients' benefits.  However, in terms of the pathologic mechanisms, the gastric metastases could also be due to secondary or concurrent dissemination of metastases at bones or lymph nodes, at a very late stage.

In the case reported in the paper, the patient also suffered bone metastases while he got the symptoms like heartburns. The authors should further clarify whether patients in the previous case studies had the ongoing/replased major metastases (bone, lymph nodes, liver and lung) while diagnosed with new metastases in the stomach. 

The authors mentioned staining with CK 7 and CK 20 and CDX2. The authors should note the rationale of using these markers to conclude the identity of prostate cancer biopsy.

The authors claimed in their conclusion that identifying the origin of gastric malignant samples could save the patient from the morbidity of noncurative gastric surgery. The authors should clearly describe here the expectation of OS extension for noncurative gastric surgery with reasonable references. Only when the expected life span extension is significantly than the 9 months in the reported case can the authors claim "saving" the patients from the morbidity of surgery.  

Author Response

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Reviewer 3 Report

In this manuscript, the Authors described a case report of a metastatic castration-resistant prostate cancer patient with distant metastasis to the stomach. Furthermore, the Authors summarized other similar cases previously published in the literature.

The case is well-written, with detailed information. In addition, the Authors provided their perspectives based on the reported case description.

Here I report my comments and suggestions:

-I suggest the Authors change the name of the paragraphs (Introduction, Material and Methods, Results, Discussion, Conclusion), following the CARE guidelines (https://www.care-statement.org/). I suggest using: Introduction, Case description, Discussion, and Conclusion.

-I suggest adding the unit of measurement for every value reported in the manuscript (e.g. PSA, hemoglobin…)

-Lines 102-109: I suggest moving these lines in the Discussion. They are not related to the case description. In contrast, they provide interesting perspectives suitable for the Discussion paragraph

-Lines 110-117: This is an important "take home message" of this case report. I suggest adding it to the conclusion and the abstract as well.

-Table 1: Firstly, I recommend using a "landscape" orientation instead of a "Portrait" orientation. Secondly, I suggest adding a column with the "histology subtype" of prostate cancer. Furthermore, I suggest changing "metastasis" to "metastatic" in the column "Stage at the diagnosis". In addition, I suggest removing the column "Treatment status at the time of gastric metastases" and adding a new column where the Authors report which kind of treatment the patient has received for the gastric metastasis.

-I suggest adding some radiological and/or endoscopic images of the gastric metastasis.

-I suggest adding a figure representing a schema with the trend of the PSA level during the patient's clinical history (x=time and y=PSA level), correlating the PSA level with the more relevant episodes of care of the patient.

-Line 214: Is there a space for other therapeutic options (PARP, ARSI, radiopharmaceutical drugs) in these cases? I suggest adding perspectives on the potential role of these agents.

-Line 221: Is "Prognosis" the name of a subparagraph?

-Has the patient had a family history of other tumors? I suggest adding these details to the case description.

Author Response

Thank you for your comments. A word file has been uploaded and reply point by point has been made.

Author Response File: Author Response.docx

Round 2

Reviewer 3 Report

The Authors have adequately addressed my concerns.