Although prostate cancer is one of the most commonly encountered malignanci
es in clinical practice, it is very unusual for prostate cancer to metastas
ize to the small bowel. Our search of the literature found no such cases pu
blished from 1966 to the present. We report the case of a 69-year-old man w
ho presented for evaluation of anasarca and anorexia. He had a history of p
rostate cancer diagnosed 9 years before and had undergone a radical prostat
ectomy with subsequent radiotherapy for positive tumor margins. He develope
d anasarca 2 years before presentation to us. His serum albumin ranged betw
een 1.5 and 2.5 g/dL. Upper endoscopy was performed for possible protein-lo
sing enteropathy and the appearance of gastric and duodenal mucosa was foun
d to be normal. Random small bowel biopsies revealed submucosal infiltratin
g adenocarcinoma with positive prostate-specific antigen stains consistent
with the diagnosis of prostate cancer metastatic to the small bowel. This i
s a rare presentation of metastatic prostate cancer. Even though prostate c
ancer is the most commonly diagnosed cancer in American men, antemortem dia
gnosis of small bowel metastasis has not been reported. In patients with un
explained anasarca, especially with a history of malignancy, an upper endos
copy with small bowel biopsy may be useful in establishing the diagnosis.