Spinal Leptomeningeal Metastases from Prostate Cancer

Abstract

Prostate cancer is a well known cause of spinal column metastases; however, an intradural location is extremely rare. It is considered to be a type of leptomeningeal spread. Cerebral seeding has usually occurred by the time of presentation. Due to a poor prognosis, surgery is rarely indicated, and controversially discussed. We review the known cases of spinal leptomeningeal prostate cancer spread, including our patient, who developed paraparesis over 6 weeks, 3 years after prostate cancer was diagnosed. Following surgical decompression and resection, the patient additionally received radiation therapy of the spinal meninges and antihormonal treatment. Six months after surgery, the patient is still ambulatory with a good quality of life. Spinal leptomeningeal metastases occur at a late stage of systemic disease, and the prognosis is generally poor. In literature, outcomes after surgery are reported as devastating, with mortality and morbidity rates of up to 20 and 60%. The aim of surgery is to relieve pain, preserve or even restore neurological function, and reveal histology if uncertain. This may be achieved by debulking the tumor without placing the patient at an unacceptably high risk. Surgery should be performed in selected cases of spinal leptomeningeal metastases, in patients who are still ambulatory with controlled systemic disease, and should be followed by adjuvant therapy.