In the evolution of metastatic prostate cancer, the most frequent metastatic involvement is bone, followed by lymph nodes out from pelvis, and less frequently the visceral involvement. The nervous system spread is very rare and late, and extraordinarily rare leptomeningeal lesions, finding few references in the literature. The clinical features are characterized by neurological deficit at different levels and fast deterioration.We describe the case of a patient 77 years old, affected by very high-risk prostate cancer in initial stage T3bN1M0 treated with Radiotherapy the pelvic volume, seminal vesicles and prostate, combined with androgen deprivation for 24 months. At 32 months follow-up, the patient presents fast neurological loss and radiological diagnosis of metastatic leptomeningeal involvement above lumbar and sacral levels. We proceeded to urgent irradiation of those affected spinal segments, with good initial response and complete neurological recovery. Later, the patient presented again fast and progressive deterioration, with multiple organ failure that caused his death.
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