Bacterial Meningitis Following Robot-Assisted Radical Prostatectomy After Neoadjuvant Precision Oncology-Directed...

To our knowledge, bacterial meningitis following radical prostatectomy has not been previously reported. We present a 69-year-old male who had phosphatase and tensin homolog (PTEN)-deficient high-risk locoregional prostate cancer and received neoadjuvant leuprolide, abiraterone, prednisone, and capivasertib in the Single-Arm Phase II Study of Neoadjuvant Intensified Androgen Deprivation in Combination with protein kinase B (AKT) Inhibition (SNARE) trial and developed bacterial meningitis following robot-assisted radical prostatectomy. Diagnosis was established by cerebrospinal fluid analysis demonstrating leukocytosis and markedly elevated protein, although cultures were negative following prior antibiotic exposure. Though capivasertib is not considered overtly immunosuppressive, it is possible that a combination of androgen deprivation, low-dose steroids, alcohol use disorder, and surgical intervention resulted in a permissive immunologic environment for infection. This represents, to our knowledge, the first documented case of bacterial meningitis arising after radical prostatectomy. The relationship to his neoadjuvant therapy remains unclear.