Brain Metastatic Prostate Adenocarcinoma: Avoiding Mistaken Identities

Area of Science:

• Oncology
• Radiology
• Neurosurgery

Background:

• Prostate cancer brain metastases are uncommon, posing diagnostic challenges.
• [68Ga]PSMA PET/CT is vital for staging but can show false positives in CNS lesions.
• Distinguishing prostate metastases from other brain tumors like meningiomas is crucial.

Observation:

• A 70-year-old male with high-risk prostate cancer presented with a solitary brain lesion on [68Ga]PSMA PET/CT and MRI.
• The lesion's differential diagnosis included prostate metastasis, meningioma, or another primary tumor.
• Histopathology confirmed the lesion as metastatic prostate adenocarcinoma.

Findings:

• The patient underwent successful surgical resection, followed by stereotactic Gamma Knife radiosurgery (GKRS) and androgen deprivation therapy (ADT).
• Fifteen months post-treatment, imaging showed stable disease, indicating durable local and systemic control.
• This case underscores the effectiveness of GKRS for brain metastatic prostate cancer.

Implications:

• Accurate diagnosis of brain metastatic prostate cancer requires integrating clinical, radiographic, and histopathologic data.
• The study emphasizes the need for histologic confirmation due to potential [68Ga]PSMA PET/CT false positives.
• GKRS offers durable local control for rare brain metastatic prostate adenocarcinoma cases.