Presentation, Treatment, and Outcomes of Dural Metastases in Men with Metastatic Castrate-Resistant Prostate Cancer: A Case Series

Abstract

Purpose: Men with metastatic castrate-resistant prostate cancer (mCRPC) have shown increased survival since the introduction of docetaxel-based chemotherapy in 2004. While bone metastases are common in prostate cancer, cranial dural metastases (DM) are not. We hypothesize that longer survival in patients with mCRPC may increase the incidence of uncommon metastatic sites, including the cranial dura. We describe 10 cases of DM in men with mCRPC and review the relevant literature. Materials and Methods: We conducted a retrospective chart review of 10 subjects with mCRPC, diagnosed antemortem with DM at our institution between August 1, 2003 and June 1, 2008. Variables analyzed included prognostic factors at prostate cancer diagnosis, number of therapies prior to DM, treatments administered for DM with response achieved, and survival following diagnosis of DM. Results: Median age at prostate cancer diagnosis was 59 years (range, 52-80), with a median Gleason's score of 9 (range, 8-10) and prostate-specific antigen (PSA) of 37 ng/dL (range, 4.9-118). Fifty percent had metastatic disease at initial diagnosis. A median of 5 therapies (range, 1-13) were administered prior to diagnosis of DM, including a median of 1 course of chemotherapy (range, 1-3). Cranial neuropathies were the most common presenting symptoms of DM, and 8 of 10 patients received treatment for their DM, most often radiotherapy. Median survival for this group was 6.17 months (range, < 1-15). Conclusions: Treatment advances in mCRPC may lead to an increased incidence of previously rare metastatic sites. CNS symptoms in men with mCRPC should prompt evaluation for DM.

Prostate dural metastasis presenting as chronic subdural hematoma. A case report and review of the literature

“…This theory has gained credence over the years due to the presence of concomitant vertebral metastases, often multiple and extensive in the cases reported. [ 6 ]…”

“…In a small series ( n = 10) reported by Lawton et al ., the median survival from diagnosis of dural metastases was just 6.7 months. [ 6 ] The authors of this series hypothesize that the improved survival of patients with aggressive, castrate-resistant prostate cancer due to improved medical therapies, for example, docetaxel-based chemotherapy, is leading to an increase in rare manifestations such as dural metastases and as such we can expect to see a rise in the incidence.…”

Prolonged Remission of Fulminant Castrate-Resistant Prostate Cancer: A Case Report

“…Some case reports have suggested that the longer survival achievable since docetaxel was introduced in 2004 has resulted in metastases seen more often in uncommon sites, including the cranial dura. 8 Indeed, Tremont-Lukats et al 9 showed that the dura is the most common intracranial site of PC metastasis. Dural metastasis is associated with very poor prognosis in PC patients: Lawton et al 8 reported median survival of about 6 months in a group of CRPC patients with dural metastases.…”

Cancer around the brain

“…Dural metastasis occurs less frequently and may mimic subdural hematoma or be associated with effusions. 7 In rare cases, dural metastases can appear in the posterior fossa and thus resemble meningioma. A number of tumors spread through cavities such as the nasal cavity, the orbit, 8 the oral cavity, and the soft palate 9 as well as through other locations including the eyelids, 10 the lacrimal glands, the parotid, and several locations in the neck.…”