Presentation, treatment, and outcomes of dural metastases in men with metastatic castrate-resistant prostate cancer: a case series.
OBJECTIVE
Men with metastatic castrate-resistant prostate cancer (mCRPC) have shown increased survival since the introduction of docetaxel-based chemotherapy in 2004. While bone metastases are common in prostate cancer, cranial dural metastases (DM) are not. We hypothesize that longer survival in patients with mCRPC may increase the incidence of uncommon metastatic sites, including the cranial dura. We describe 10 cases of DM in men with mCRPC and review the relevant literature.


METHODS
We conducted a retrospective chart review of 10 subjects with mCRPC, diagnosed ante-mortem with DM at our institution between August 1, 2003 and June 1, 2008. Variables analyzed included prognostic factors at prostate cancer diagnosis, number of therapies prior to DM, treatments administered for DM with response achieved, and survival following diagnosis of DM.


RESULTS
Median age at prostate cancer diagnosis was 59 years (range, 52-80), with a median Gleason's score of 9 (range, 8-10) and prostate-specific antigen (PSA) of 37 ng/dL (range, 4.9-118). Fifty percent had metastatic disease at initial diagnosis. A median of 5 therapies (range, 1-13) were administered prior to diagnosis of DM, including a median of 1 course of chemotherapy (range, 1-3). Cranial neuropathies were the most common presenting symptoms of DM, and 8 of 10 patients received treatment for their DM, most often radiotherapy. Median survival for this group was 6.17 months (range, < 1-15).


CONCLUSIONS
Treatment advances in mCRPC may lead to an increased incidence of previously rare metastatic sites. CNS symptoms in men with mCRPC should prompt evaluation for DM.
Lawton
Andrew
A
Medical College of Wisconsin, Milwaukee, Wisconsin, USA. alawton@mcw.edu
Sudakoff
Gary
G
Dezelan
Lisa C
LC
Davis
Nancy
N
D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D014408:Biomarkers, Tumor / Q000032:analysis; D003287:Contrast Media; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000032:analysis; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D014408:Biomarkers, Tumor; D003287:Contrast Media; D017430:Prostate-Specific Antigen