Knight James A, Ene Andre N, El Khouli Riham H, Myint Zin W, St Clair William
Radiation Medicine, University of Kentucky, Lexington, USA.
Pathology and Laboratory Medicine, University of Kentucky, Lexington, USA.
Cureus. 2024 Sep 12;16(9):e69282. doi: 10.7759/cureus.69282. eCollection 2024 Sep.
Brain metastatic carcinoma is a rare occurrence among prostate cancer metastases. Gallium prostate-specific membrane antigen PET-CT ([Ga]PSMA PET/CT) is commonly used for prostate cancer staging and detection of biochemical recurrences. However, various CNS tumors exhibit activity on [Ga]PSMA PET/CT and may often be included in the differential diagnosis. Herein, we present a case of brain metastatic prostate cancer successfully treated with surgical resection and adjuvant stereotactic Gamma Knife radiosurgery (GKRS) followed by androgen deprivation therapy (ADT) to emphasize the need for histologic confirmation. A 70-year-old male with a history of very high-risk prostatic adenocarcinoma presented with biochemical recurrence following radical prostatectomy and irradiation of the prostatic fossa. [Ga]PSMA PET/CT and MRI identified a solitary lesion in the left occipital lobe; differential diagnosis included prostate metastasis, meningioma, or a new metastatic primary lesion. The patient underwent surgical resection, and immunohistochemical staining confirmed the lesion as brain metastatic prostate adenocarcinoma. One month after resection, the patient underwent GKRS to the tumor bed and two additional metastases, followed by ADT. Repeated imaging 15 months after GKRS revealed stable posttreatment changes with no evidence of new metastases, thus demonstrating durable, effective local and systemic control. Brain metastatic prostate adenocarcinoma without nodal or osseous metastases is a rare phenomenon. The affinity of [Ga]PSMA PET/CT for non-prostate histologies such as meningioma introduces uncertainty into the diagnostic process. This case demonstrates the durable local control conferred by GKRS toward these lesions and emphasizes the need for clinical, radiographic, and histopathologic data to identify disease presentations and facilitate appropriate treatment regimens.
脑转移癌在前列腺癌转移中较为罕见。镓前列腺特异性膜抗原PET-CT（[Ga]PSMA PET/CT）常用于前列腺癌分期及生化复发的检测。然而，多种中枢神经系统肿瘤在[Ga]PSMA PET/CT上表现出活性，常被纳入鉴别诊断。在此，我们报告一例脑转移前列腺癌患者，成功接受手术切除及辅助立体定向伽玛刀放射外科治疗（GKRS），随后进行雄激素剥夺治疗（ADT），以强调组织学确诊的必要性。一名70岁男性，有极高风险前列腺腺癌病史，在根治性前列腺切除及前列腺窝放疗后出现生化复发。[Ga]PSMA PET/CT及MRI在左枕叶发现一个孤立病灶；鉴别诊断包括前列腺转移、脑膜瘤或新的转移性原发灶。患者接受了手术切除，免疫组化染色证实该病灶为脑转移前列腺腺癌。切除术后1个月，患者对肿瘤床及另外两处转移灶接受了GKRS治疗，随后进行ADT。GKRS治疗15个月后重复成像显示治疗后改变稳定，无新转移灶证据，从而证明了持久、有效的局部及全身控制。无淋巴结或骨转移的脑转移前列腺腺癌是一种罕见现象。[Ga]PSMA PET/CT对非前列腺组织学如脑膜瘤的亲和力给诊断过程带来了不确定性。本病例展示了GKRS对这些病灶所赋予的持久局部控制，并强调需要临床、影像学和组织病理学数据来识别疾病表现并促进适当的治疗方案。
