Tumore della Prostata
Anderson Cancer Center, Houston, Texas. Use the link below to share a full-text version of this article with your friends and colleagues. Learn more. In patients with prostate carcinoma, brain metastasis has most commonly been reported in autopsy series. Symptomatic brain metastasis from prostate carcinoma has occasionally been detected.
Anderson Cancer Center. The mean time from diagnosis of prostate carcinoma to discovery of brain metastasis was 28 months, with a mean survival of 9. The brain metastasis was treated only with whole Posner della prostata irradiation in 29 patients, with craniotomy and irradiation in 8 patients, and with surgery alone in 1 patient. Small cell carcinomas and primary transitional cell carcinomas of the prostate were much more likely Posner della prostata produce brain metastasis than were adenocarcinomas.
Also noted among the overall prostate carcinoma cohort was Posner della prostata second group of 16 patients with prostate carcinoma and brain metastasis that had developed from a second primary tumor, which in all was either lung carcinoma or melanoma. The occurrence of brain metastasis in prostate carcinoma patients Posner della prostata rare, usually signifies a late stage of the disease, and may in some patients be produced by a tandem extraprostatic tumor.
Cancer Posner della prostata Prostate carcinoma has the highest Posner della prostata of any cancer in males, with almostnew cases expected in the United States in The remaining patients carry distant metastases that are most likely to involve the axial skeleton. Although prostate carcinoma frequently metastasizes to the spine, intracranial metastasis is unusual.
Most reports of brain metastases from prostate carcinoma come from large autopsy series 4 - 8 and from occasional case reports. In addition, because of the high incidence and relatively long survival seen in patients with prostate carcinoma, coexisting primary tumors in extraprostatic sites logically can occur in these patients. Such data are particularly important in view of the increasing numbers of patients being diagnosed with prostate carcinoma. Because recent improvements in treatment allow patients to live longer, 4344 the incidence of brain metastases in prostate carcinoma may be rising despite the occurrence of such tumors Posner della prostata late in the course of the disease.
We retrospectively reviewed all patients with prostate carcinoma who registered at the University of Texas M. Anderson Cancer Center between January 1, and December 31, A total of patients with prostate carcinoma were treated during this time period, 54 0. Medical evaluation in 38 0. The presence Posner della prostata a brain Posner della prostata was diagnosed by either computed tomography CT or magnetic resonance imaging MRI.
Within the same prostate carcinoma cohort, a second subgroup was identified containing 16 0. The remaining patients had unclassified carcinoma or unclassified neoplasm in general. The variables reviewed with respect to the primary lesion also included tumor histology and grade and stage 45 at Posner della prostata.
All patients had metastatic surveys for systemic disease at presentation and at regular intervals thereafter. These included bone scans and CT of the chest, abdomen, and pelvis. When systemic extracerebral metastases were present, the location and time of development relative to the onset of brain metastases also were noted. The variables considered with respect to the brain included Posner della prostata interval between diagnosis of the primary tumor and diagnosis of the brain metastasis DFI by clinical or radiologic criteria, whichever occurred first ; the location and number of brain tumors; whether surgery, radiotherapy, or chemotherapy was used; and patient survival in months after Posner della prostata of brain metastases.
The number and location of metastatic lesions in the brain were determined from CT and MRI scans of the brain. All patients received dexamethasone after the diagnosis of brain tumor. For patients with true intracerebral metastasis from prostate carcinoma of any histology, the mean age at diagnosis of the brain metastasis was For adenocarcinoma, SCC, and transitional cell carcinoma, the respective mean ages were In patients with a second primary tumor, the mean age at diagnosis of brain metastases was Patients with prostate carcinoma metastatic to the brain developed intracerebral tumor a mean of The mean DFI was One patient presented with neurologic Posner della prostata, was shown by MRI to have a cerebral tumor suggestive of metastases, and then underwent a metastatic survey that revealed his prostate carcinoma.
A total of 93 metastases were seen in the 38 patients. One case involved the Posner della prostata, and 1 involved the hypothalamus. Anderson scheme of histologic grading, 47 according to which 4 patients had Grade 1 tumors, 9 patients had Grade 2 tumors, 3 patients had Grade 3 tumors, and 8 patients had Grade 4 tumors.
In 6 patients, the brain was the sole site Posner della prostata metastases. All but 1 of these patients received radiotherapy. One patient Table 2case 31 had two craniotomies to excise solitary metastases and presented 10 months after the first operation with radiologic evidence of leptomeningeal dissemination of tumor.
He received intrathecal chemotherapy through an Ommaya reservoir. For patients who died, the mean survival after the discovery of the prostate brain metastases was 9. Those patients with SCC had a mean survival of 11 months. For those patients with adenocarcinoma, the mean overall survival was 6. It was 4. Anderson histologic Grade 1 tumors, Posner della prostata different stages of adenocarcinoma at primary presentation, the mean survival was 1.
Analysis by treatment group revealed that the mean survival after the diagnosis of brain metastases for those patients who were treated with surgery and irradiation was One Posner della prostata was not treated at the primary prostatic site. The corresponding mean DFI values for the first 5 of the aforementioned treatment classifications were The mean DFI values for adenocarcinoma after presentation with disease of the prostate were For small cell carcinoma, Posner della prostata Stage D, it was 32 months.
In 1 other patient, detection of the nonprostate primary tumor preceded discovery of the prostate carcinoma by Posner della prostata months. All of these patients had prostatic Posner della prostata. Three patients who were diagnosed simultaneously had lung carcinoma, and 1 had melanoma.
Of the 16 patients, only 4 had Posner della prostata, which provided definitive histologic classification of the brain metastasis. The most common sources of metastases to the brain are carcinoma of the lung, breast, and kidney, and melanoma. The incidence of brain metastases from prostatic neoplasms in our study was 0. In their autopsy series of cases, Catane et al. A Japanese series showed a prevalence of 2. However, Posner della prostata et al.
Clinical treatment of metastatic prostate carcinoma to the brain has been described only in small clinical series and in occasional case reports. Consequently, it may serve as a source of information on the epidemiology and expected outcome of patients with this condition. In past reports, many Posner della prostata with prostate metastases to the brain were asymptomatic when they were alive, Posner della prostata their cerebral disease was Posner della prostata only incidentally at autopsy.
In our series, 8 patients with brain metastases were asymptomatic, and intracranial lesions were found during metastatic survey. The remaining Posner della prostata presented with signs and symptoms similar to those seen in patients with other types of brain tumors. Sarma and Godeau 7 stated that patients with metastatic prostate carcinoma most commonly present with headache, paresis, or seizure. In the current series, only 2 patients presented with seizures.
The remaining patients presented with multiple overlapping signs and symptoms, including confusion, weakness, aphasia, visual disturbances, and ataxia. It is important to recognize that symptoms from prostate metastases may be confused with those of an ischemic or hemorrhagic event, both of which are common entities in the age group in which prostate carcinoma is prevalent.
Although they were absent from our series, metastatic brain lesions from prostate carcinoma presenting as meningiomas or subdural hematomas have been noted by others. Lippman et al.
Those patients both had hyperostotic lesions that involved the left frontal bone and the left temporal lobe. Both had cerebral angiograms that showed a vascular pattern suggestive of meningioma. A few patients have presented initially with brain metastases prior to recognition of their prostate carcinoma. Kunkler and Cooksey 25 reported a patient Posner della prostata 71 years who was not known to have carcinoma but who presented with left hemiparesis caused by prostatic metastasis.
Other authors have reported similar patients who presented with gait difficulty and hemianopia, 24 with headache, 10 and with ataxia. One patient in our series initially presented with diplopia and difficulty walking.
His ensuing medical evaluation revealed a pontine mass and prostate carcinoma. Consequently, Posner della prostata prostate should not be neglected as a possible source of the metastases in male patients presenting with brain metastases without any known site of primary tumor. The patterns of metastatic spread reported by others for adenocarcinoma of the prostate suggest that bone and lymph nodes pelvic, retroperitoneal, and paraaortic are the most common sites of spread.
In the analysis of Saitoh et al. The other 2 patients had tumors in 2 extraprostatic sites; in no patients did the brain contain the only focus of metastases.
Our patients showed a similar distribution of metastatic disease. These data combined with a mean DFI of over 28 months underscore the late position of brain metastases in the Posner della prostata chronology of prostate carcinoma. Patients with prostate carcinoma who develop metastases to the brain have been noted to be younger than those without brain metastases.
Lynes et Posner della prostata. Catane et al. In our series, the age discrepancy was not as apparent. Patients with prostate carcinoma had a mean age of The role of prostate specific antigen PSA in the early detection of Posner della prostata metastases from prostate carcinoma is unclear. This glycoprotein is a sensitive indicator of the presence of disease, and elevated levels commonly are taken to mean persistence or renewal of tumor, both locally and at distant sites, and to correlate with tumor volume.
Because the current series included patients who were treated before this test was introduced, only fragmentary PSA data were available and have been excluded from consideration here. One Posner della prostata with new brain and Posner della prostata visceral metastases without an elevated PSA level has been reported, 27 but it is Posner della prostata to propose that new tumor in the intracerebral compartment should provoke rises in the PSA level.