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Brain metastasis from prostate small cell carcinoma: not to be neglected
Corrie E Erasmus1, Wim I M Verhagen, Carla A P Wauters
1Department of Neurosurgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
Background:
Symptomatic brain metastases from prostatic carcinoma are rare (0.05% to 0.5%).
Case Report:
A 70-year-old man presented with a homonymous hemianopsia due to brain metastatic prostatic carcinoma shortly before becoming symptomatic of prostatic disease. CT and MRI of the brain showed a tumour deep in the right hemisphere near the thalamus and involving the optic radiation.
Results:
Routine haematological and biochemical tests were normal. The prostate specific antigen level was low on two separate occasions. The prostatic and brain tumours showed identical appearances, namely of a poorly differentiated adenocarcinoma with neuroendocrine differentiation (small cell carcinoma).
Conclusion:
A literature review suggests that small cell carcinoma of the prostate is more likely to spread to the brain compared to adenocarcinoma and that brain metastases indicate a poor prognosis. The prostate gland should be remembered as a possible cause of brain metastases and that a normal serum prostate specific antigen does not exclude this diagnosis.