Brain Metastasis from Prostate Small Cell Carcinoma: Not to be Neglected

• Published in: Canadian journal of neurological sciences 2002-11, Vol.29 (4), p.375-377
• Main Authors: Erasmus, Corrie E., Verhagen, Wim I.M., Wauters, Carla A.P., Lindert, Erik J. van
• Format: Article
• Language: English
• Subjects: Aged; Brain Neoplasms - blood; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - secondary; Carcinoma, Small Cell - blood; Carcinoma, Small Cell - diagnostic imaging; Carcinoma, Small Cell - pathology; Carcinoma, Small Cell - secondary; Humans; Magnetic Resonance Imaging; Male; Prognosis; Prostate-Specific Antigen - blood; Prostatic Neoplasms - blood; Prostatic Neoplasms - pathology; Tomography, X-Ray Computed
• ISSN: 0317-1671; 2057-0155
• DOI: 10.1017/S0317167100002250

Symptomatic brain metastases from prostatic carcinoma are rare (0.05% to 0.5%). A 70-year-old man presented with a homonymous hemianopsia due to brain metastatic prostatic carcinoma shortly before becoming symptomatic of prostatic disease. CT and MRI of the brain showed a tumour deep in the right hemisphere near the thalamus and involving the optic radiation. Routine haematological and biochemical tests were normal. The prostate specific antigen level was low on two separate occasions. The prostatic and brain tumours showed identical appearances, namely of a poorly differentiated adenocarcinoma with neuroendocrine differentiation (small cell carcinoma). A literature review suggests that small cell carcinoma of the prostate is more likely to spread to the brain compared to adenocarcinoma and that brain metastases indicate a poor prognosis. The prostate gland should be remembered as a possible cause of brain metastases and that a normal serum prostate specific antigen does not exclude this diagnosis.