Cranial nerve involvement with carcinoma of prostate

Eleven patients with known prostate cancer presented with cranial nerve deficits and skull metastases during the course of their disease. All were treated with radiation therapy to the base of skull. Of the 11 patients, 10 (91%) responded to therapy. Four of the patients in the responder group had complete resolution of the cranial nerve deficits. This response lasted until their death. One patient had a complete response but later relapsed and is still alive. He is the only survivor of the 11 patients. Partial responses were achieved in 5 patients. These patients had either improvement but not resolution of the cranial nerve deficit or, in cases of multiple nerve involvement, there was response of some of the involved nerves. Four of the partial responders retained the response until their death. One patient achieved partial response but later relapsed with additional nerve deficits. The development of this problem represented a grave prognostic factor as 10 patients died within a median of five months (range 1-16 months) after presentation. One patient is alive nineteen months later but in poor condition with disease progression. Only 1 patient (9%) did not achieve any response to therapy. His treatment was not completed due to deterioration of his general health. The seventh cranial nerve was the most frequently involved either alone or in combination with other nerves. The most commonly used treatment schedule was 3,000 rad in 10 treatments (7 cases). We conclude that effective palliation is achieved though short survival is possible.