Abstract
Fewer than 2% of patients with metastatic prostate cancer (pca) develop brain metastases. Autopsy series have confirmed the rarity of brain metastases. When present, brain metastases occur in end stage, once the pca is castrate-resistant and spread to other sites is extensive. Here, we present a rare case of a patient with pca who developed a solitary parenchymal brain metastasis as first site of relapse 9 years after radical therapy. The patient underwent craniotomy and excision of the tumour. A second recurrence was also isolated to the brain. In the literature, pca patients with brain metastases have a poor mean survival of 1-7.6 months. The patient in our case report experienced a relatively favourable outcome, surviving 19 months after his initial brain relapse.
Highlights
CASE DESCRIPTIONProstate cancer is the most common cancer in men and the 2nd leading cause of cancer death in North America[1]
Brain metastasis is a rare event in pca
Cns metastases occur at the end stage of illness, once patients have castrate-resistant disease
Summary
Prostate cancer (pca) is the most common cancer in men and the 2nd leading cause of cancer death in North America[1]. Imaging (brain mri, abdominopelvic computed tomography, bone scan, and chest radiography) showed no evidence of tumour recurrence or metastatic disease. Brain mri (Figure 4) demonstrated significant disease recurrence, with multiple extra-axial dura-based enhancing lesions overlying the right hemisphere and left convexity. The patient was initiated on oral dexamethasone 2 mg twice daily, experiencing an improvement in his symptoms He was treated with whole-brain radiotherapy 3000 cGy in 10 fractions. In June 2014, the patient was admitted to hospital with generalized weakness, dehydration, and diffuse bone pain He displayed features consistent with disseminated intravascular coagulation secondary to his malignancy and was treated with supportive care. He died 1 week after the hospital admission and more than 19 months after his initial brain recurrence
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