Prostatic meningeal carcinomatosis with low serum level of prostate-specific antigen

Leptomeningeal metastases from prostate cancer: an emerging clinical conundrum

Leptomeningeal metastases from solid tumors are relatively uncommon events with dismal prognosis. They can be seen mainly in patients with breast and lung cancer, and malignant melanoma, but have also been described in a variety of other tumor types. Leptomeningeal carcinomatosis from prostate cancer is an extremely rare complication, but as patients' survival is prolonged due to more effective treatments, it is expected that more patients will present with leptomeningeal involvement in advanced stages of the disease. In these cases high levels of prostate-specific antigen can be found in the cerebrospinal fluid. This comprehensive review presents the recent findings from the literature.

Increased detections of leptomeningeal presentations in men with hormone refractory prostate cancer: an effect of improved systemic therapy?

Metastases from prostate cancer occur largely in bone through a haematogenous route. Metastatic spread of prostate cancer to the leptomeninges was rarely seen in the past. However, there has been a recent increase in presentations of leptomeningeal spread from prostate cancer in our institutions. Between 2004 and 2006, four patients were diagnosed with metastatic prostate cancer with leptomeningeal metastases in our centres. All four patients had hormone refractory prostate cancer and had previously had chemotherapy. The median survival of these patients was approximately 15 months from the time of hormone refractoriness. The prognosis of leptomeningeal metastasis secondary to metastatic prostate cancer is poor, ranging from 2 to 7 months as seen in our series. New cases of leptomeningeal metastases seen in our series are hypothesized to be secondary to the use of effective modern systemic treatments. A parallel might be drawn with the increased rate of central nervous system metastases in breast cancer since the introduction of effective cytotoxic treatments and more recently targeted therapies. We suggest the clinicians to be aware of the potential change of natural history and pattern of progression in metastatic prostate cancer.