Department of Internal Medicine, Trinity Health Ann Arbor Hospital, 5301 McAuley Dr, Ypsilanti, MI, 48197, USA.
Department of Hematology and Oncology, Trinity Health Ann Arbor Hospital, 5301 McAuley Dr, Ypsilanti, MI, 48197, USA.
J Med Case Rep. 2024 Oct 30;18(1):532. doi: 10.1186/s13256-024-04840-5.
Leptomeningeal metastasis occurs in 5% of patients with prostate cancer and indicates a very poor prognosis.
A 60-year-old Caucasian male patient diagnosed with metastatic castration-resistant prostate cancer with sclerotic bone metastases and soft tissue metastases underwent multiple courses of chemotherapy and hormone therapy. The diagnosis of prostate cancer is based on elevated prostate-specific antigen levels and tissue biopsy. He subsequently presented with expressive aphasia. Nonspecific, diffuse irregular dural/pachymeningeal thickening enhancement was noted on magnetic resonance imaging. Upon evaluation by neurology, electroencephalogram was negative for an epileptiform correlate. The workup included a lumbar puncture to rule out infectious etiology. The patient's neurological status stabilized, and he was discharged home with a plan for continued therapy with abiraterone and prednisone. Due to advanced malignancy, the patient enrolled in hospice and died 3 weeks after hospital discharge.
Central nervous system metastasis occurs very rarely in prostate cancer. With the increase in life expectancy and advances in oncologic therapy for prostate cancer, physicians should be aware of and consider central nervous system metastasis in men aged 50 years and above.
脑膜转移发生在 5%的前列腺癌患者中，预后极差。
一名 60 岁的白人男性患者，诊断为转移性去势抵抗性前列腺癌，伴骨硬化转移和软组织转移，接受了多次化疗和激素治疗。前列腺癌的诊断基于前列腺特异性抗原水平升高和组织活检。随后，他出现表达性失语。磁共振成像显示非特异性、弥漫性不规则硬脑膜/脑脊膜增厚增强。神经科评估时，脑电图未见癫痫样相关性。检查包括腰椎穿刺以排除感染性病因。患者的神经状态稳定，出院回家继续接受阿比特龙和泼尼松治疗。由于恶性肿瘤晚期，患者入住临终关怀病房，在出院后 3 周死亡。
中枢神经系统转移在前列腺癌中非常罕见。随着预期寿命的延长和前列腺癌的肿瘤治疗进展，医生应意识到并考虑 50 岁及以上男性的中枢神经系统转移。
