Fronto-orbital metastasis of a prostatic adenocarcinoma

The Clinical, Diagnostic, Therapeutic, and Prognostic Characteristics of Brain Metastases in Prostate Cancer: A Systematic Review

“…Following the completion of the study selection process, as shown in Figure 1 , a total of 59 eligible studies [ 9 , 10 , 13 – 24 , 26 – 30 , 32 , 36 – 74 ] (902 PCa patients with brain BMs) were included in this systematic review. Details regarding the included studies such as the year of publication, type of the study (case report or case series), sample size, and the quality assessment are presented in Table 1 .…”

“…Fifty-seven [ 9 , 10 , 13 – 24 , 26 – 30 , 32 , 36 – 39 , 41 , 43 – 74 ] out of the 59 studies including 852 patients had reported BMs in PCa patients presenting with several clinical manifestations ranging from general symptoms such as hematuria, increased urinary frequency, and weakness to neurologic signs and symptoms such as aphasia, dysphasia, dysarthria, hemiplegia, headache, dizziness, confusion, double vision, visual field cut, ataxia, seizures, delirium, dementia, loss of appetite, and even behavioral changes. Moreover, different diagnostic methods including prostate-specific antigen (PSA), brain computed tomography (CT), brain magnetic resonance imaging (MRI), bone scan, multispectral immunofluorescence, immunohistochemistry (IHC), DNA sequencing, positron emission tomography (PET), prostate biopsy, and CSF analysis were used to diagnose BM in patients with PCa.…”

“…As shown in Table 3 , 901 patients from fifty-eight [ 9 , 10 , 13 – 24 , 26 – 30 , 32 , 36 – 40 , 42 – 74 ] out of the 59 studies had demonstrated varied therapeutic approaches such as immunotherapy, ADT, whole-brain radiation therapy (WBRT), craniotomy, prostatectomy, adjuvant radiation therapy, docetaxel chemotherapy, and medications such as abiraterone, prednisone, pembrolizumab, dexamethasone, bicalutamide, and leuprorelin. Additionally, the prognostic overview of the PCa patients developing BMs was not promising.…”

“…As described in Table 2 , these include symptoms such as headache, nausea, vomiting, seizures, confusion, weakness, aphasia, visual disturbances, ataxia, motor dysfunction, mono/hemiparesis, mental status or behavioral changes, cranial nerve dysfunction, and delirium. It was also demonstrated that patients can be asymptomatic, and the diagnosis of BMs in PCa may be an incidental finding during other investigations [ 9 , 10 , 13 – 24 , 26 – 30 , 32 , 36 – 39 , 41 , 43 – 74 , 76 , 77 ].…”

“…PCa patients with BMs are often in the end stages of the disease, or they may also have other accompanying chronic illnesses such as atherosclerosis, which may hide their CNS involvement and make the diagnosis even more challenging. Due to these multiple factors, cranial nerve and pituitary tumor spread, tumor mass effect, and meningeal involvement with hemorrhage of the contiguous brain tissue are frequently missed in these patients [ 9 , 10 , 13 – 24 , 26 – 30 , 32 , 36 – 39 , 41 , 43 – 74 , 76 , 77 , 80 – 83 ].…”