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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 5  |  Issue : 1  |  Page : 75-76

Isolated brain metastasis from prostate cancer: A case report


1 MS, DNB Urology, MS, MCH Urology, Christian Medical College, Ludhiana, Punjab, India
2 Department of Urology, Christian Medical College, Ludhiana, Punjab, India

Date of Web Publication12-Jan-2018

Correspondence Address:
Kim Jacob Mammen
Department of Urology, Christian Medical College, Ludhiana - 141 008, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_27_17

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  Abstract 


Brain metastases arising from prostate cancer are exceedingly rare and generally 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 an 80-year-old male with adenocarcinoma of the prostate presenting with isolated symptomatic brain metastasis.

Keywords: Brain metastasis, isolated, prostate cancer


How to cite this article:
Singh A, Tuli A, Mammen KJ. Isolated brain metastasis from prostate cancer: A case report. CHRISMED J Health Res 2018;5:75-6

How to cite this URL:
Singh A, Tuli A, Mammen KJ. Isolated brain metastasis from prostate cancer: A case report. CHRISMED J Health Res [serial online] 2018 [cited 2020 Aug 12];5:75-6. Available from: http://www.cjhr.org/text.asp?2018/5/1/75/223114




  Introduction Top


Prostate cancer commonly metastasizes to the pelvic lymph nodes, axial skeleton, and lungs.[1],[2] Brain metastases from prostate cancer are rare and are usually discovered postmortem. These metastases generally only occur in the context of widespread metastatic disease. It is even more uncommon to have brain as the sole site of the metastatic prostate cancer. We present the case of an 80-year-old male who presented with prostate cancer with isolated brain metastasis.


  Case Summary Top


An 80-year-old male was initially diagnosed with prostate cancer after transrectal ultrasound- guided prostate biopsy following a high prostate-specific antigen value (14 ng/ml). Biopsy revealed adenocarcinoma prostate with Gleason's score of 3 + 4 = 7/10 [Figure 1]. Bone scan revealed no bony metastasis. The patient underwent a bilateral orchiectomy in 2016. In January 2017, the patient developed an episode of generalized tonic-clonic seizure at home and was brought to the emergency department where magnetic resonance imaging brain showed multifocal supratentorial enhancing lesions with mild to moderate perilesional edema, internal heterogeneity, and blooming involving the right frontal lesion suggestive of metastasis [Figure 2] and [Figure 3].
Figure 1: Photomicrograph showing adenocarcinoma prostate (GS = 3 + 4 = 7/10)

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Figure 2: Contrast Enhanced magnetic resonance imaging showing an enhancing lesion in the right frontal lobe

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Figure 3: T2-flair magnetic resonance imaging image shows a hyperintense right frontal lesion with surrounding edema

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Neurology consult was taken and was advised to take a combination of tablet phenytoin 100 mg TID, tablet levetiracetam 500 mg BD, tablet carbamazepine 200 mg BD. The patient improved symptomatically and was discharged on these medications.


  Discussion Top


The antemortem diagnosis of a solitary metastasis to the brain from prostate cancer is exceedingly rare; our review of the literature identified 16 previously reported cases in the literature over the past 25 years.[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13] Survival in these cases generally ranged between 2 and 20 months, In one case, a patient presenting with a right cerebellar infarct following transurethral resection of the prostate 3 months earlier was reported to remain alive and symptom-free 5 years postoperatively following sub-occipital craniotomy with excision of the mass, which was noted to be moderately differentiated adenocarcinoma, and whole brain radiation therapy (WBRT) and radiotherapy to the posterior fossa.[4] For decades, surgical resection with adjuvant WBRT has been the standard of care for solitary metastases in the brain. This combined therapy strategy has been evaluated in randomized studies and found to significantly reduce the risk of recurrence when compared with surgical resection or WBRT alone. The patient got stable with anticonvulsant medication. He is currently on Tb. Bicalutamide 50 mg OD oral and phenytoin 100 mg THD. He is one regular follow-up.


  Conclusion Top


Metastatic disease exclusive to the brain in prostate cancer patients remains extremely infrequent. This unique case of an 80-year-old male with an isolated brain metastasis arising from prostate cancer demonstrates that palliative care treatment with antiandrogen and anticonvulsant is effective in managing brain metastasis at his age.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bubendorf L, Schöpfer A, Wagner U, Sauter G, Moch H, Willi N, et al. Metastatic patterns of prostate cancer: An autopsy study of 1,589 patients. Hum Pathol 2000;31:578-83.  Back to cited text no. 1
    
2.
Hess KR, Varadhachary GR, Taylor SH, Wei W, Raber MN, Lenzi R, et al. Metastatic patterns in adenocarcinoma. Cancer 2006;106:1624-33.  Back to cited text no. 2
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3.
Rao KG. Carcinoma of prostate presenting as intracranial tumor with multiple cranial nerve palsies. Urology 1982;19:433-5.  Back to cited text no. 3
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4.
Lynes WL, Bostwick DG, Freiha FS, Stamey TA. Parenchymal brain metastases from adenocarcinoma of prostate. Urology 1986;28:280-7.  Back to cited text no. 4
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5.
Kasabian NG, Previte SR, Kaloustian HD, Ganem EJ. Adenocarcinoma of the prostate presenting initially as an intracerebral tumor. Cancer 1992;70:2149-51.  Back to cited text no. 5
[PUBMED]    
6.
Kunkler RB, Cooksey G, Millac P. Carcinoma of the prostate presenting with a cerebral metastasis. Br J Urol 1993;71:103-4.  Back to cited text no. 6
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7.
Gupta A, Baidas S, Cumberlin RK. Brain stem metastasis as the only site of spread in prostate carcinoma. A case report. Cancer 1994;74:2516-9.  Back to cited text no. 7
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8.
Sutton MA, Watkins HL, Green LK, Kadmon D. Intracranial metastases as the first manifestation of prostate cancer. Urology 1996;48:789-93.  Back to cited text no. 8
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9.
McCutcheon IE, Eng DY, Logothetis CJ. Brain metastasis from prostate carcinoma: Antemortem recognition and outcome after treatment. Cancer 1999;86:2301-11.  Back to cited text no. 9
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10.
Salvati M, Frati A, Russo N, Brogna C, Piccirilli M, D'Andrea G, et al. Brain metastasis from prostate cancer. Report of 13 cases and critical analysis of the literature. J Exp Clin Cancer Res 2005;24:203-7.  Back to cited text no. 10
    
11.
Sweets T, Bracken RB, Geisler EJ, Warnick R. Intracranial treatment for solitary prostatic adenocarcinoma brain metastasis is curative. Urology 2009;73:681.e7-9.  Back to cited text no. 11
    
12.
Mithal P, Gong Y, Sirkis H. Abrain lesion as the sole metastasis of prostate cancer. J Clin Urol 2014.  Back to cited text no. 12
    
13.
Craig J, Woulfe J, Sinclair J, Malone S. Isolated brain metastases as first site of recurrence in prostate cancer: Case report and review of the literature. Curr Oncol 2015;22:e493-7.  Back to cited text no. 13
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    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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Abstract
Introduction
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Discussion
Conclusion
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