■前列腺癌的脑转移并不常见,发生在不到1%的转移性前列腺癌病例中。脑转移可引起脑水肿,神经症状,如果没有进行彻底的检查,可能会在影像学上误诊为原发性脑肿瘤。由于对颅内转移过程和表现的了解很少,并且仅限于案例研究,因此很难识别和诊断前列腺癌的脑转移。大多数前列腺癌脑转移患者表现出各种转移症状;然而,该患者的表现仅由孤立的剧烈头痛定义。我们的目标是除了回顾有关前列腺癌脑转移的治疗进展的文献外,还提请注意前列腺癌脑转移的罕见情况。
方法:我们报告一例67岁男性转移性前列腺腺癌进入大脑,出现孤立的严重头痛,没有前列腺癌的症状。经过广泛的放射学检查,在大脑左侧检测到转移性沉积物,并伴有多个脑内和小脑疣病变。多平面T2加权腹盆腔MRI显示了经组织学证实的前列腺原发性病变。手术去势一个月后,患者报告头痛缓解,并恢复日常活动.在12个月的随访期间,患者的血清PSA从7.8ng/ml降低至0.3ng/ml,无神经系统症状。
■前列腺癌很少引起脑转移,并且所有源自前列腺癌的脑转移的百分比很少更新。很难区分原发性脑病变和转移性脑前列腺癌,特别是当只有一个病变存在时。尽管最近开发了诊断方法,有症状的患者表现出多种临床表现,这些临床表现因转移灶的位置而异。这些表现包括头痛,癫痫发作,和局灶性神经功能缺损,除了一些常见的非重点表现,如混乱和记忆缺陷。我们的患者开始时的PSA为7.8ng/ml,DRE结果正常,临床上认为前列腺癌不是脑转移的主要原因。进行了腹部盆腔MRI以调查原发性病变,并确认存在前列腺外延伸的前列腺癌。进行组织病理学检查时,发现腺癌前列腺癌是主要原因。
结论:本报告回顾了有关前列腺癌脑转移的文献,并指出尽管非常罕见,前列腺癌的脑转移确实发生,不应忽视,特别是鉴于最近在前列腺癌治疗方面的进展可能延长患者的生存期。钆增强MRI是必要的,以确认或排除脑转移,如果怀疑,以及监测前列腺癌患者。
UNASSIGNED: Brain metastases from prostate cancer are uncommon, occurring in fewer than 1 % of cases of metastatic prostate cancer. Brain metastasis can cause cerebral edema, neurologic symptoms, and may be misdiagnosed as primary brain tumors on imaging if thorough investigations are not done. It is difficult to identify and diagnose brain metastasis from prostate cancer since the intracranial metastatic process and presentation are poorly understood and limited to case studies. Most patients with brain metastases from prostate cancer exhibit a variety of metastatic symptoms; however, this patient\'s presentation was defined by only isolated intense headache. Our goal is to draw attention to the uncommon instance of brain metastases from prostate cancer in addition to reviewing the literature on the advances in treatment for prostatic cancer with metastasis to the brain.
METHODS: We report the case of a 67-year-old male with metastatic prostate adenocarcinoma into the brain, presenting with isolated severe headache with no prostate cancer symptoms. Following extensive radiologic examination, metastatic deposits were detected in the left side of the brain with multiple intracerebral and cerebellar vermis lesions. Multiplanar T2 weighted abdominal pelvic MRI visualized the primary lesion in the prostate which was confirmed by histology. After a month following surgical castration, the patient reported resolved headache and resumed his daily activities. The patient\'s serum PSA decreased from 7.8 ng/ml to 0.3 ng/ml during a 12-months follow-up with no neurological symptoms.
UNASSIGNED: Prostate cancer rarely causes brain metastases, and the percentage of all brain metastases that originate from prostate cancer is seldom updated. It can be difficult to distinguish between primary brain lesions and metastatic brain prostate cancer, particularly when there is just one lesion present. Despite the recently developed diagnostic approaches, symptomatic patients exhibit a variety of clinical manifestations that vary depending on the location of the metastatic focus. These manifestations include headache, seizures, and focal neurological deficits, in addition to some common non-focal manifestations like confusion and memory deficits. Our patient had a PSA of 7.8 ng/ml at the beginning and the DRE results were normal, clinically prostate cancer was not thought to be the main cause of brain metastasis. Abdominal pelvic MRI was performed to investigate the primary lesion and confirmed the presence of prostate cancer with extra prostatic extensions. Adenocarcinoma prostate cancer was found to be the main cause when histopathology was done.
CONCLUSIONS: This report reviews the literature on brain metastases from prostate cancer and points out that while very rare, brain metastases from prostatic cancer do occur and should not be overlooked, particularly in light of the recent advancements in prostatic cancer therapies that may extend the patient\'s survival. Gadolinium-enhanced MRI is necessary to confirm or rule out brain metastases if it is suspected, as well as to monitor prostate cancer patients.