Metastatic Adenocarcinoma of the Prostate to the Brain Initially Diagnosed as Meningioma by Craniotomy: A Case Report (original) (raw)
Related papers
Cureus, 2020
Brain metastasis from prostate cancer is rare, occurring in less than 1% of metastatic prostate cancer patients. Brain metastasis can cause edema, neurologic symptoms, and may be misdiagnosed as primary brain tumors on imaging. A 68-year-old male presented to the emergency department complaining of headaches, right-sided weakness, multiple falls, and a 45 pounds of unintentional weight loss. Computerized tomography (CT) scan without contrast of the head showed a 3.2 cm right frontal mass with edema suspicious for meningioma. Associated nonspecific bony lesions were found on CT of the abdomen and pelvis. Magnetic resonance imaging (MRI) of the brain showed a 2.8 cm right frontal mass with an enhanced dural tail. Preoperative labs were noteworthy for a hemoglobin of 9.7 and prostate-specific antigen (PSA) of 66.7 ng/ml. Craniotomy with resection of tumor was performed with a frozen sample diagnosed as meningioma. Permanent pathology with stains were positive for PSA and prostatic-specific acid phosphatase (PSAP), making the diagnosis of metastatic prostate adenocarcinoma. Postoperatively, nuclear bone scan showed uptake in the axial skeleton consistent with metastasis. After the diagnosis of metastatic prostate cancer was made, bicalutamide was administered followed by degarelix with plans to transition to leuprorelin one month later. This is to be followed up by whole brain radiation therapy (WBRT). PSA was 118.53 ng/ml three weeks after craniotomy, but prior to androgen deprivation therapy. Metastatic prostate cancer can present with neurological symptoms most commonly following spread to the axial skeleton and impingement of the spinal cord. Metastasis to the brain is rare and is usually associated with vague symptomatology depending on extent and location of the lesion. While brain metastasis can occur in known prostate cancer patients, this case shows that metastasis can occur prior to any formal prostate cancer diagnosis and can be mistaken for meningioma on imaging and frozen sectioning. Practitioners must be vigilant, and precautions should be taken to rule in metastatic prostate cancer as a possible cause for a brain lesion in patients of the appropriate demographics.
Brain metastasis from prostate carcinoma
Cancer, 1999
BACKGROUND. In patients with prostate carcinoma, brain metastasis has most commonly been reported in autopsy series. Symptomatic brain metastasis from prostate carcinoma has occasionally been detected.
Brain Metastasis From Prostate Adenocarcinoma: Case Report and Review of Literature
World Journal of Oncology, 2012
It is rare for prostate carcinoma to metastasize to the central nervous system. It often represents a terminal event with death in one year frequently due to the advanced systemic disease. Starting by a case report, we also reviewed the relevant literature to focus on this uncommon entity from epidemiology to clinical manifestation and therapeutic strategies. In this article, a case of multiple brain prostate metastasis is reported and a review of relevant literature is also discussed. Treatments available for intracranial metastasis include neurosurgery, external beam radiation and hormonal manipulation. Surgery associated with whole brain radiotherapy seems to be effective in the control of brain lesions both relieving neurological symptoms and prolonging survival, even if prognosis remains dismal. From this case, we concluded that brain metastasis from prostate carcinoma is a rare, terminal event with death in one year frequently due to the advanced systemic disease. A better understanding of the biology of prostate carcinoma will help clarify the basis for its metastasis to the brain.
Brain metastasis from prostate carcinoma: Antemortem recognition and outcome after treatment
Cancer, 1999
Brain Metastasis from Prostate Carcinoma Antemortem Recognition and Outcome after Treatment W e read with interest the article on brain metastasis from prostate carcinoma (CaP) by McCutcheon et al. 1 published in Cancer. For the benefit of the readers, we would like to update and refine the data regarding solitary brain metastasis from CaP. Using the MEDLINE database, we reviewed the data concerning brain metastasis and prostate carcinoma in living patients from 1960 to 1999. We excluded patients who lacked a negative metastatic survey and a brain biopsy consistent with CaP. We found a total of eight patients who met our criteria. Sites of single metastasis included pons alone (one patient), pons at the cerebellar-pontine angle (one patient), pons and cerebral peduncle (one patient), pons and cerebellar peduncle (one patient), pons and midbrain (one patient), the parietal lobe (one patient), the temporal lobe (one patient), and the frontoparietal lobe (one patient). Brain biopsy yielded seven patients with CaP and one patient with papillary adenocarcinoma. Brain histology included poorly differentiated (two patients), moderately differentiated (one patient), and well differentiated (four patients) CaP. The rate of incidence of brain metastasis from CaP in the recent study by McCutcheon et al. was 0.7%. 1 One study proposes four reasons for the low incidence rate of clinically suspect solitary brain metastasis from CaP: 1) lower detection rate of tumor spread to brain (even in autopsy data), 2) late occurrence of brain involvement in the course of the disease, 3) clinically silent growth related to the most common site of tumor involvement, and 4) rare and nonspecific symptoms due to brain metastasis from CaP. 2,3 Another hypothesis for the rarity of solitary brain metastases in patients with CaP is that the brain parenchyma does not represent "fertile soil" for CaP cells, just as, conversely, the skeleton provides a preferential milieu for these cells. 4 We believe our review shows the highest percentage of prostate metastasis to the pons Ϯ cerebrum, cerebellum, and midbrain reported to date. McCutcheon et al.'s large series included only three patients who had metastatic disease solely to the brain. One patient had metastases specifically to the hypothalamus and the right temporal lobe. The other two patients had multiple frontal metastases. Their review also included seven additional patients who presented with a solitary brain metastasis. To our knowledge the study by Gupta et al. was the only analysis that met the criteria for our study. 5 The number of solitary brain metastasis from CaP may indeed be higher than previously thought. McCutcheon et al. were correct to speculate that given the obscuring effect of bone artifact in the posterior fossa on computed tomography (CT) scans of the brain, tumor in this location actually may be underreported when CT is the primary method used. The fact that magnetic resonance imaging diagnosed all the patients with a solitary brain metastasis to the pons lends support to their theory.
Prostate Cancer
Aim. Prostate cancer (PCa) is the second most common nonskin malignancy and the second most common cause of cancer-related deaths in men. The most common site of metastasis in PCa is the axial skeleton which may lead to back pain or pathological fractures. Hematogenous spread to the brain and involvement of the central nervous system (CNS) are a rare occurrence. However, failed androgen deprivation therapy (ADT) may facilitate such a spread resulting in an advanced metastatic stage of PCa, which carries a poor prognosis. Methods. In this systematic review, we searched the PubMed, Scopus, and Web of Science online databases based on the PRISMA guideline and used all the medical subject headings (MeSH) in terms of the following search line: (“Brain Neoplasms” OR “Central Nervous System Neoplasms”) and (“Prostatic Neoplasms” OR “Prostate”). Related studies were identified and reviewed. Results. A total of 59 eligible studies (902 patients) were included in this systematic review. In or...
2021
Prostate cancer is the most common cancer and among the leading causes of cancer death in men and its clinical symptoms vary a lot. The most common metastatic site is the bones, but rarely prostate cancer can metastasize to brain in very advanced stages of the disease. However, brain metastases giving neurological symptoms as first manifestation of prostate cancers have been reported. Research of international literature revealed only seventeen patients (including our own) that were diagnosed with prostate cancer presented with neurological symptoms.
Brain metastases from prostate cancer: A single-center experience
Turkish journal of urology, 2018
Metastases from prostate cancer to the brain are very unusual and very few case series have been reported in the literature. Present study was performed to assess the proportion of brain metastasis from prostate cancer among other brain metastasis in men, to evaluate the distribution, pattern and magnetic resonance imaging (MRI) appearance of these metastatic lesions, and prognosis of brain metastasis in patients with prostate cancer. Between January 2010 and November 2016, 339 males who had received radiotherapy at our department were retrospectively reviewed. After the first evaluation of patients data, we reviewed only the patients with brain metastases from prostate cancer. We evaluated MRI characteristics of metastatic brain lesions and characteristics of the patients, tumor and treatment modalities. Ten of 339 patients (2.9%) had brain metastases from prostate cancer. Sixty percent of the patients had pure intraparenchymal metastasis, 20% of the patients had pure extensive dur...
Metastatic prostate adenocarcinoma invading an atypical meningioma
Journal of Clinical Neuroscience, 2011
Although prostate adenocarcinoma is the most commonly diagnosed cancer in men, intracranial metastases are rare. We describe a 72-year-old patient with known metastatic prostate cancer, presenting with a dural-based parafalcine lesion on radiological imaging, following a seizure. Total macroscopic excision of the lesion was achieved at surgery, with histopathology confirming prostate adenocarcinoma embedded in an atypical (World Health Organization Grade II) meningioma, fulfilling all the criteria for true tumour-to-tumour metastasis. To our knowledge, this is the first report of prostate cancer metastasising to an atypical meningioma.
Solitary Brain Metastasis: A Rare Initial Presentation of Prostate Carcinoma
Cureus, 2019
Cerebral metastasis as an initial clinical presentation of prostate carcinoma is extremely rare. Usually, patients have widespread metastasis in the body before presenting with brain metastasis. In the absence of extensive metastasis, especially without bony metastasis, only brain metastasis is an unusual presentation of the disease. We report a case of a 59-years-old patient who presented with a lack of concentration and decreased vision. Magnetic resonance imaging (MRI) of the brain revealed a large right parietal-occipital space-occupying lesion. He underwent surgery and the pathological diagnosis of the tumor turned out to be metastatic prostate carcinoma. Further evaluation by a whole-body computed tomography (CT) scan revealed an enlarged prostate with no other metastatic deposit and a mildly raised level of prostate-specific antigen (PSA). It was possible for us to provide this patient with multimodality treatment with the help of multidisciplinary tumor board meetings. Further studies addressing the biological as well as clinical characteristics of prostate carcinoma with this rare metastatic presentation will help us to define prognostic factors and therapeutic intervention and will help us to understand the basis of this unique presentation without bone metastasis.
Solitary brain metastasis from prostate cancer: a case report
Annals of palliative medicine, 2016
Brain metastases arising from prostate cancer are exceedingly rare and typically occur late in the course of the disease. Most patients have widespread metastatic disease before developing brain metastases from prostate cancer. We report the case of a 67-year-old male with prostate cancer presenting with an isolated symptomatic brain metastasis. Aggressive treatment of the metastatic site included tumor resection and adjuvant stereotactic radiation treatment (RT) to the surgical bed, resulting in a favorable outcome.