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+A 64-year-old man consulted in May 2006 for facial dysaesthesia and left palpebral ptosis and proptosis of the eyeball on the same side.
+Personal history of arterial hypertension under medical treatment, operated on for duodenal ulcus 20 years earlier, and laryngeal polyposis on two occasions in 1993 and 1994.
+Diagnosed with prostatic adenocarcinoma by ultrasound biopsy in September 2005, with PSA of 794, alkaline phosphatase of 870, and bone scan showing multiple bone metastases. At that time, treatment was started with lh-rh analogues, flutamide and zoledronic acid 4 mg every 21 days for 6 months. The nadir PSA was reached in January 2006 at 36-17 ng/ml.
+Days before admission, he reported right facial numbness from the cheekbone to the upper lip, and simultaneously left palpebral ptosis together with ocular protrusion. There was no diplopia, facial or ocular pain.
+On physical examination, the patient was conscious, oriented and cooperative, presenting left palpebral ptosis with protrusion of the eye on the same side, with no apparent murmur, with paresis of the left third and sixth pairs. He also presented alterations in the sensitivity of the right half of the face, with the rest of the motor and sensory neurological examination being normal.
+Among the complementary tests, blood tests showed GGT of 86, alkaline phosphatase of 1145, and a PSA of 121-02.
+Brain MRI and angio MRI were performed, which showed supratentorial ischaemic lesions and an orbital mass of extraconal location attached to the left orbital roof that displaced and caudally engulfed the superior rectus muscle, while the left frontal sinus was occupied by a mass with the same characteristics as the one described. The superior orbital rim remains intact with no apparent signs of infiltration. The obliteration of the fat of the upper extraconal fat leads to inferior displacement and ocular proptosis. There is also an expansive mass located in the right maxillary sinus that breaks the lateral wall and extends towards the soft tissues, causing interruption of the floor of the right orbit and invasion of the inferior extraconal space, displacing the inferior rectus muscle without invading it. The cavernous sinuses were free.
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+The thoraco-abdomino-pelvic computerised axial tomography diagnosed a bony pattern with vertebral blast-lytic infiltration, without visceral alterations.
+Metastasis of prostatic adenocarcinoma was diagnosed in the right maxillary sinus and left frontal sinus, with extraconal right inferior and left superior orbital involvement.
+Local radiotherapy was ruled out due to the risk of blindness. Flutamide was withdrawn as treatment, and the lh-rh analogue was maintained. In June 2006, treatment was started with docetaxel 70 mg/m2 every 21 days, together with prednisone 10 mg per day. Six cycles were completed by the end of September 2006.
+A nadir PSA level of 6-8 ng/mL was reached in July 2006, after the first two administrations of docetaxel. The patient reported a decrease in left ocular proptosis. Six cycles were completed, with excellent tolerance. In October 2006 the PSA was 149 ng/ml, with no change in the MRI images. Recently, in January 2007, treatment was restarted again with docetaxel and prednisone.
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