title: Prostate-specific antigen in the cerebrospinal fluid leads to diagnosis of solitary cauda equina metastasis: a unique case report and review of the literature.
abstract: A 79-year-old male patient presented with a subacute cauda syndrome caused by an intradural metastasis of the lumbosacral caudate fibres from an adenocarcinoma of the prostate, which had been treated 5 years earlier with external beam radiation therapy. Diagnosis could not be established by repeated magnetic resonance images (MRIs) during a 2-year period of increasingly severe radicular pain. Eventually, a small tumour mass could be visualized on the fourth MRI. Repeated normal serum prostate-specific antigen (PSA) did not hint at a prostate cancer metastasis (range 2.4-5.1 ng ml(-1)); however, PSA in the cerebrospinal fluid was found to be elevated (29.1 ng ml(-1)). Empirical radiation therapy of the caudate region did not improve radicular pain. Therefore, an exploratory surgical procedure was conducted, which confirmed the suspicion of an intradural prostate cancer metastasis. In conclusion, PSA in the cerebrospinal fluid provides a useful diagnostic tool for detecting intradural prostate cancer metastasis.
authors.affiliation: Department of Neurological Surgery, University Hospitals, Basle, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Schaller
authors.forename: A
authors.initials: A
authors.lastname: Merlo
authors.forename: E
authors.initials: E
authors.lastname: Kirsch
authors.forename: K
authors.initials: K
authors.lastname: Lehmann
authors.forename: P R
authors.initials: PR
authors.lastname: Huber
authors.forename: P
authors.initials: P
authors.lastname: Lyrer
authors.forename: A J
authors.initials: AJ
authors.lastname: Steck
authors.forename: O
authors.initials: O
authors.lastname: Gratzl
mesh_terms: D000230:Adenocarcinoma / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000556:secondary*; D000368:Aged; D002420:Cauda Equina; D006801:Humans; D008297:Male; D010524:Peripheral Nervous System Neoplasms / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000556:secondary*; D017430:Prostate-Specific Antigen / Q000134:cerebrospinal fluid*; D011471:Prostatic Neoplasms / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000473:pathology
chemical_list: D017430:Prostate-Specific Antigen