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Ludwig ML, Moline D, Horrmann A, Boytim E, Larson G, Arafa AT, Sayeda M, Lozada JR, Bergom HE, Day A, Dasaraju S, Dehm SM, Murugan P, Hwang J, Drake JM, Antonarakis ES. Integrated multi-omics assessment of lineage plasticity in a prostate cancer patient with brain and dural metastases. NPJ Precis Oncol 2024; 8:215. [PMID: 39349591 PMCID: PMC11443004 DOI: 10.1038/s41698-024-00713-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 09/16/2024] [Indexed: 10/04/2024] Open
Abstract
Metastases to the brain are rare in prostate cancer. Here, we describe a patient with two treatment-emergent metastatic lesions, one to the brain with neuroendocrine prostate cancer (NEPC) histology and one to the dural membrane of adenocarcinoma histology. We performed genomic, transcriptomic, and proteomic characterization of these lesions and the primary tumor to investigate molecular features promoting these metastases. The two metastatic lesions had high genomic similarity, including TP53 mutation and PTEN deletion, with the most striking difference being the additional loss of RB1 in the NEPC lesion. Interestingly, the dural lesion expressed both androgen receptor and neuroendocrine markers, suggesting amphicrine carcinoma (AMPC). When analyzing pioneer transcription factors, the AMPC lesion exhibited elevated FOXA1 activity while the brain NEPC lesion showed elevated HOXC10, NFYB, and OTX2 expression suggesting novel roles in NEPC formation or brain tropism. Our results highlight the utility of performing multi-omic characterization, especially in rare cancer subtypes.
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Affiliation(s)
- Megan L Ludwig
- Department of Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - David Moline
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Alec Horrmann
- Department of Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - Ella Boytim
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Gabrianne Larson
- Department of Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - Ali T Arafa
- Department of Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - Masooma Sayeda
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - John R Lozada
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Hannah E Bergom
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Abderrahman Day
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Sandhyarani Dasaraju
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Scott M Dehm
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Paari Murugan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Justin Hwang
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Justin M Drake
- Department of Pharmacology, University of Minnesota, Minneapolis, MN, USA.
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
- Department of Urology, University of Minnesota, Minneapolis, MN, USA.
| | - Emmanuel S Antonarakis
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA.
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
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Trofin AM, Buzea CG, Buga R, Agop M, Ochiuz L, Iancu DT, Eva L. Predicting Tumor Dynamics Post-Staged GKRS: Machine Learning Models in Brain Metastases Prognosis. Diagnostics (Basel) 2024; 14:1268. [PMID: 38928683 PMCID: PMC11203132 DOI: 10.3390/diagnostics14121268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/03/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
This study assesses the predictive performance of six machine learning models and a 1D Convolutional Neural Network (CNN) in forecasting tumor dynamics within three months following Gamma Knife radiosurgery (GKRS) in 77 brain metastasis (BM) patients. The analysis meticulously evaluates each model before and after hyperparameter tuning, utilizing accuracy, AUC, and other metrics derived from confusion matrices. The CNN model showcased notable performance with an accuracy of 98% and an AUC of 0.97, effectively complementing the broader model analysis. Initial findings highlighted that XGBoost significantly outperformed other models with an accuracy of 0.95 and an AUC of 0.95 before tuning. Post-tuning, the Support Vector Machine (SVM) demonstrated the most substantial improvement, achieving an accuracy of 0.98 and an AUC of 0.98. Conversely, XGBoost showed a decline in performance after tuning, indicating potential overfitting. The study also explores feature importance across models, noting that features like "control at one year", "age of the patient", and "beam-on time for volume V1 treated" were consistently influential across various models, albeit their impacts were interpreted differently depending on the model's underlying mechanics. This comprehensive evaluation not only underscores the importance of model selection and hyperparameter tuning but also highlights the practical implications in medical diagnostic scenarios, where the accuracy of positive predictions can be crucial. Our research explores the effects of staged Gamma Knife radiosurgery (GKRS) on larger tumors, revealing no significant outcome differences across protocols. It uniquely considers the impact of beam-on time and fraction intervals on treatment efficacy. However, the investigation is limited by a small patient cohort and data from a single institution, suggesting the need for future multicenter research.
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Affiliation(s)
- Ana-Maria Trofin
- University of Medicine and Pharmacy “Grigore T. Popa” Iași, 700115 Iasi, Romania; (A.-M.T.); (L.O.); (D.T.I.)
| | - Călin Gh. Buzea
- Clinical Emergency Hospital “Prof. Dr. Nicolae Oblu” Iași, 700309 Iasi, Romania; (C.G.B.); (L.E.)
- National Institute of Research and Development for Technical Physics, IFT Iași, 700050 Iasi, Romania
| | - Răzvan Buga
- University of Medicine and Pharmacy “Grigore T. Popa” Iași, 700115 Iasi, Romania; (A.-M.T.); (L.O.); (D.T.I.)
- Clinical Emergency Hospital “Prof. Dr. Nicolae Oblu” Iași, 700309 Iasi, Romania; (C.G.B.); (L.E.)
| | - Maricel Agop
- Physics Department, Technical University “Gheorghe Asachi” Iasi, 700050 Iasi, Romania;
| | - Lăcrămioara Ochiuz
- University of Medicine and Pharmacy “Grigore T. Popa” Iași, 700115 Iasi, Romania; (A.-M.T.); (L.O.); (D.T.I.)
| | - Dragos Teodor Iancu
- University of Medicine and Pharmacy “Grigore T. Popa” Iași, 700115 Iasi, Romania; (A.-M.T.); (L.O.); (D.T.I.)
- Regional Institute of Oncology, 700483 Iasi, Romania
| | - Lucian Eva
- Clinical Emergency Hospital “Prof. Dr. Nicolae Oblu” Iași, 700309 Iasi, Romania; (C.G.B.); (L.E.)
- University Apollonia, 700511 Iasi, Romania
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Weiten R, Niemann M, Below E, Friker LL, Ralser DJ, Toma M, Kristiansen G, Hahn O, Zechel S, Grünwald V, Bald T, Siewert J, Pietsch T, Ritter M, Hölzel M, Eckstein M, Alajati A, Krausewitz P, Klümper N. Preclinical evidence for the use of anti-Trop-2 antibody-drug conjugate Sacituzumab govitecan in cerebral metastasized castration-resistant prostate cancer. Cancer Med 2024; 13:e7320. [PMID: 38895886 PMCID: PMC11185941 DOI: 10.1002/cam4.7320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 04/01/2024] [Accepted: 05/07/2024] [Indexed: 06/21/2024] Open
Abstract
PURPOSE Improved survival rates have been observed in castration-resistant prostate cancer (CRPC) due to advancements in treatment options. However, individuals with brain metastases still have limited therapeutic options and an unfavorable prognosis. Therefore, there is an urgent need to explore new therapeutic avenues, such as antibody-drug conjugates (ADCs), which have demonstrated significant clinical activity against active brain metastases in solid tumors. Our objective was to determine the expression levels of the ADC targets Trop-2 and NECTIN-4 in cerebral metastasized CRPC (mCRPC). METHODS Immunohistochemical staining of Trop-2 and NECTIN-4 with evaluation of H-score was performed in CRPC brain metastases (n = 31). Additionally, we examined Trop-2 protein expression in prostate cancer cell lines and studied their responsiveness to the anti-Trop-2 ADC Sacituzumab govitecan (SG) in vitro. RESULTS Our analysis revealed that most patients exhibited moderate to strong Trop-2 expression [n = 27/31 with H-score ≥100, median H-score 220 (IQR 180-280)], while NECTIN-4 was absent in all cerebral metastases. Mechanistically, we demonstrated that the efficacy of SG depends on Trop-2 expression levels in vitro. Overexpression of Trop-2 in Trop-2-negative PC-3 cells led to sensitization to SG, whereas CRISPR-Cas9-mediated knockdown of Trop-2 in Trop-2-expressing DU-145 cells conferred resistance to SG. CONCLUSION The substantial expression of Trop-2 in cerebral metastases, along with our preclinical in vitro results, supports the efficacy of SG in treating cerebral mCRPC. Thus, our results extend the understanding of the potential of ADCs in prostate cancer treatment and provide an additional treatment strategy for the challenging subset of patients with cerebral metastases.
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Affiliation(s)
- Richard Weiten
- Department of Urology and Paediatric UrologyUniversity Hospital BonnBonnGermany
- Department of Urology Uro‐Oncology, Robot‐Assisted and Specialized Urologic SurgeryUniversity Hospital CologneKölnGermany
| | - Max Niemann
- Department of Urology and Paediatric UrologyUniversity Hospital BonnBonnGermany
| | - Eduard Below
- Department of Urology and Paediatric UrologyUniversity Hospital BonnBonnGermany
- Institute of Experimental OncologyUniversity Hospital BonnBonnGermany
| | - Lea L. Friker
- Institute of Experimental OncologyUniversity Hospital BonnBonnGermany
- Institute of NeuropathologyUniversity Hospital BonnBonnGermany
| | - Damian J. Ralser
- Institute of Experimental OncologyUniversity Hospital BonnBonnGermany
- Department of Gynaecology and Gynaecological OncologyUniversity Hospital BonnBonnGermany
| | - Marieta Toma
- Institute of PathologyUniversity Hospital BonnBonnGermany
| | | | - Oliver Hahn
- Department of UrologyUniversity Hospital GöttingenGöttingenGermany
| | - Sabrina Zechel
- Institute of NeuropathologyUniversity Hospital GöttingenGöttingenGermany
| | - Viktor Grünwald
- Clinic for Internal Medicine (Tumor Research) and Clinic for Urology, Interdisciplinary Genitourinary Oncology at the West‐German Cancer CenterUniversity Hospital EssenEssenGermany
| | - Tobias Bald
- Institute of Experimental OncologyUniversity Hospital BonnBonnGermany
| | - Johannes Siewert
- Institute of Experimental OncologyUniversity Hospital BonnBonnGermany
| | - Torsten Pietsch
- Institute of NeuropathologyUniversity Hospital BonnBonnGermany
| | - Manuel Ritter
- Department of Urology and Paediatric UrologyUniversity Hospital BonnBonnGermany
| | - Michael Hölzel
- Institute of Experimental OncologyUniversity Hospital BonnBonnGermany
| | - Markus Eckstein
- Institute of PathologyUniversity Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | - Abdullah Alajati
- Department of Urology and Paediatric UrologyUniversity Hospital BonnBonnGermany
| | - Philipp Krausewitz
- Department of Urology and Paediatric UrologyUniversity Hospital BonnBonnGermany
| | - Niklas Klümper
- Department of Urology and Paediatric UrologyUniversity Hospital BonnBonnGermany
- Institute of Experimental OncologyUniversity Hospital BonnBonnGermany
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Banha R, Coutada A, Faustino C. Treatment Challenges in a Patient With Two Distinct Malignancies and Brain Metastases. Cureus 2024; 16:e60728. [PMID: 38903358 PMCID: PMC11187520 DOI: 10.7759/cureus.60728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 06/22/2024] Open
Abstract
Prostate cancer (PC) is one of the leading causes of cancer death among men worldwide. Brain metastases from PC are very rare, often presenting in advanced stages of the disease, and are associated with a poor prognosis. Treatment is complex and may involve surgery or radiotherapy. We present the case of a 64-year-old male diagnosed with localized prostate adenocarcinoma, initially treated with pelvic radiotherapy associated with long-term hormonal treatment. While on this hormonal treatment, around one year after radical treatment initiation, he developed bilateral pulmonary metastases, histologically proven to be related to PC, defining a state of metastatic castration-resistant PC. He was asymptomatic and therefore treatment with enzalutamide was initiated. A partial response to the lung lesions was obtained and maintained for more than a year, at which time new mediastinal lymph node metastases were identified. An endobronchial ultrasound biopsy revealed metastases from carcinoma with neuroendocrine differentiation, favoring lung small-cell carcinoma. The patient started chemotherapy with carboplatin and etoposide, with a response. Due to the progression of the mediastinal lymph nodes after eight months, the patient had to undergo chemotherapy again, this time in combination with atezolizumab, with once again partial response. Given the possibility of drug interactions, enzalutamide was suspended during both cycles of chemotherapy and successfully reintroduced afterward. Three months after restarting enzalutamide, he began complaining of headaches. Brain imaging revealed a single frontobasal lesion, without evidence of simultaneous extracerebral progression. Considering the epileptogenic potential of enzalutamide, it was again suspended. The patient underwent surgery and histology revealed metastases of prostate adenocarcinoma, a very rare finding. Systemic re-staging after surgery revealed the progression of cerebral and extra-cerebral disease. The patient is currently proposed for treatment with whole brain radiotherapy and chemotherapy with docetaxel. This case demonstrates the difficulties associated with the diagnosis and treatment of a patient with two distinct neoplasms. Therapy choices were necessarily adjusted because of significant drug interactions. The diagnosis of brain lesions was the last complication, and it proved to be a challenge as it is a rare entity, with optimal management options not being well established.
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Affiliation(s)
- Rita Banha
- Medical Oncology, Hospital do Divino Espírito Santo de Ponta Delgada, Ponta Delgada, PRT
| | - Andreia Coutada
- Pathology, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Centre Raquel Seruca, Porto, PRT
| | - Cátia Faustino
- Medical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, PRT
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Nhungo CJ, Kitua DW, Nzowa B, Kasori M, Sensa V, Mkony C. Advanced prostate cancer with brain metastasis presenting with isolated severe headache without urinary symptoms.: Case report and literature review. Int J Surg Case Rep 2024; 117:109458. [PMID: 38458020 PMCID: PMC10937825 DOI: 10.1016/j.ijscr.2024.109458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION AND CLINICAL IMPORTANCE Brain metastases from prostate cancer are uncommon, occurring in fewer than 1 % of cases of metastatic prostate cancer. Brain metastasis can cause cerebral edema, neurologic symptoms, and may be misdiagnosed as primary brain tumors on imaging if thorough investigations are not done. It is difficult to identify and diagnose brain metastasis from prostate cancer since the intracranial metastatic process and presentation are poorly understood and limited to case studies. Most patients with brain metastases from prostate cancer exhibit a variety of metastatic symptoms; however, this patient's presentation was defined by only isolated intense headache. Our goal is to draw attention to the uncommon instance of brain metastases from prostate cancer in addition to reviewing the literature on the advances in treatment for prostatic cancer with metastasis to the brain. CASE PRESENTATION We report the case of a 67-year-old male with metastatic prostate adenocarcinoma into the brain, presenting with isolated severe headache with no prostate cancer symptoms. Following extensive radiologic examination, metastatic deposits were detected in the left side of the brain with multiple intracerebral and cerebellar vermis lesions. Multiplanar T2 weighted abdominal pelvic MRI visualized the primary lesion in the prostate which was confirmed by histology. After a month following surgical castration, the patient reported resolved headache and resumed his daily activities. The patient's serum PSA decreased from 7.8 ng/ml to 0.3 ng/ml during a 12-months follow-up with no neurological symptoms. CLINICAL DISCUSSION Prostate cancer rarely causes brain metastases, and the percentage of all brain metastases that originate from prostate cancer is seldom updated. It can be difficult to distinguish between primary brain lesions and metastatic brain prostate cancer, particularly when there is just one lesion present. Despite the recently developed diagnostic approaches, symptomatic patients exhibit a variety of clinical manifestations that vary depending on the location of the metastatic focus. These manifestations include headache, seizures, and focal neurological deficits, in addition to some common non-focal manifestations like confusion and memory deficits. Our patient had a PSA of 7.8 ng/ml at the beginning and the DRE results were normal, clinically prostate cancer was not thought to be the main cause of brain metastasis. Abdominal pelvic MRI was performed to investigate the primary lesion and confirmed the presence of prostate cancer with extra prostatic extensions. Adenocarcinoma prostate cancer was found to be the main cause when histopathology was done. CONCLUSION This report reviews the literature on brain metastases from prostate cancer and points out that while very rare, brain metastases from prostatic cancer do occur and should not be overlooked, particularly in light of the recent advancements in prostatic cancer therapies that may extend the patient's survival. Gadolinium-enhanced MRI is necessary to confirm or rule out brain metastases if it is suspected, as well as to monitor prostate cancer patients.
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Affiliation(s)
- Charles John Nhungo
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Department of Urology, Muhimbili National Hospital, Dar es salaam, Tanzania.
| | - Daniel W Kitua
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Boniface Nzowa
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mukama Kasori
- Department of Urology, Muhimbili National Hospital, Dar es salaam, Tanzania
| | - Victor Sensa
- Department of Urology, Muhimbili National Hospital, Dar es salaam, Tanzania
| | - Charles Mkony
- Department of Surgery, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Mahmoud AM, Childs DS, Ahmed ME, Tuba Kendi A, Johnson GB, Orme JJ, Stish BJ, Phillips RM, Park SS, Davis BJ, Andrews JR, Kwon ED. Treatment modalities and survival outcomes in prostate cancer parenchymal brain metastasis. Prostate 2024; 84:237-244. [PMID: 37899635 DOI: 10.1002/pros.24643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/07/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Prostate cancer (PCa) parenchymal brain metastases are uncommon and troubling observations in the course of the disease. Our study aims to evaluate the prevalence of brain metastases among PCa patients while reporting various therapeutic modalities, clinical features, and oncological outcomes. METHODS We retrospectively identified 34 patients with parenchymal brain metastasis out of 4575 patients using a prospectively maintained database that contains clinicopathologic characteristics of PCa patients between January 2012 and December 2021. Based on the three treatment modalities used, the patients were divided into three groups: stereotactic radiosurgery (SRS), whole brain radiotherapy (WBRT), and systemic therapy alone. The Kaplan-Meier curve was used to calculate overall survival [OS] probability and the Cox proportional hazards regression model was used to compare between groups. RESULTS At the time of brain metastasis diagnosis, the median age was 66 years, the median (interquartile range [IQR]) prostate-specific antigen (PSA) was 2.2 (0.1-26.6) ng/ml and the median (IQR) months from initial PCa diagnosis to brain metastasis development was 70.8 (27.6-100.9). The median (IQR) primary Gleason score was 8 (7-9) and over a median (IQR) follow-up time of 2.2 (1.2-16.5) months, 76.5% (n = 26) of the patients died. Thirteen (38.2%) patients had solitary lesion, whereas 21 (61.8%) had ≥2 lesions. The lesions were supratentorial in 19 (55.9%) patients, infratentorial in six (17.6%), and both sides in nine (26.5%). Among all 34 patients, 10 (29.4%) were treated with SRS, seven (20.6%) with WBRT, and 17 (50%) with systemic therapy alone. OS varied greatly between the three treatment modalities (log-rank test, p = 0.049). Those who were treated with SRS and WBRT had better OS compared with patients who were treated with systemic therapy alone (hazard ratio: 0.37, 95% confidence interval: 0.16-0.86, p = 0.022). CONCLUSIONS In our single-institutional study, we confirmed that PCa brain metastasis is associated with poor survival outcomes and more advanced metastatic disease. Furthermore, we found that SRS and WBRT for brain metastasis in patients with recurrent PCa appear to be associated with improved OS as compared with systemic therapy alone and are likely secondary to selection bias.
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Affiliation(s)
- Ahmed M Mahmoud
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel S Childs
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamed E Ahmed
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - A Tuba Kendi
- Department of Radiology, Division of Nuclear Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Geoffrey B Johnson
- Department of Radiology, Division of Nuclear Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jacob J Orme
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan M Phillips
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jack R Andrews
- Department of Urology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Eugene D Kwon
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
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Loos NHC, Martins MLF, de Jong D, Lebre MC, Tibben M, Beijnen JH, Schinkel AH. Coadministration of ABCB1/P-glycoprotein inhibitor elacridar improves tissue distribution of ritonavir-boosted oral cabazitaxel in mice. Int J Pharm 2024; 650:123708. [PMID: 38135258 DOI: 10.1016/j.ijpharm.2023.123708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
Developing an oral formulation for the chemotherapeutic cabazitaxel might improve its patient-friendliness, costs, and potentially exposure profile. Cabazitaxel oral availability is restricted by CYP3A-mediated first-pass metabolism, but can be substantially boosted with the CYP3A inhibitor ritonavir. We here tested whether adding the ABCB1/P-glycoprotein inhibitor elacridar to ritonavir-boosted oral cabazitaxel could further improve its tissue exposure using wild-type, CYP3A4-humanized and Abcb1a/b-/- mice. The plasma AUC0-2h of cabazitaxel was increased 2.3- and 1.9-fold in the ritonavir- and ritonavir-plus-elacridar groups of wild-type, and 10.5- and 8.8-fold in CYP3A4-humanized mice. Elacridar coadministration did not influence cabazitaxel plasma exposure. The brain-to-plasma ratio of cabazitaxel was not increased in the ritonavir group, 7.3-fold in the elacridar group and 13.4-fold in the combined booster group in wild-type mice. This was 0.4-, 4.6- and 3.6-fold in CYP3A4-humanized mice, illustrating that Abcb1 limited cabazitaxel brain exposure also during ritonavir boosting. Ritonavir itself was also a potent substrate for the Abcb1 efflux transporter, limiting its oral availability (3.3-fold) and brain penetration (10.6-fold). Both processes were fully reversed by elacridar. The tissue disposition of ritonavir-boosted oral cabazitaxel could thus be markedly enhanced by elacridar coadministration without affecting the plasma exposure. This approach should be verified in selected patient populations.
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Affiliation(s)
- Nancy H C Loos
- The Netherlands Cancer Institute, Division of Pharmacology, Amsterdam, The Netherlands
| | - Margarida L F Martins
- The Netherlands Cancer Institute, Division of Pharmacology, Amsterdam, The Netherlands
| | - Daniëlle de Jong
- The Netherlands Cancer Institute, Division of Pharmacy and Pharmacology, Amsterdam, The Netherlands
| | - Maria C Lebre
- The Netherlands Cancer Institute, Division of Pharmacology, Amsterdam, The Netherlands
| | - Matthijs Tibben
- The Netherlands Cancer Institute, Division of Pharmacy and Pharmacology, Amsterdam, The Netherlands
| | - Jos H Beijnen
- The Netherlands Cancer Institute, Division of Pharmacology, Amsterdam, The Netherlands; The Netherlands Cancer Institute, Division of Pharmacy and Pharmacology, Amsterdam, The Netherlands; Utrecht University, Faculty of Science, Department of Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht, The Netherlands
| | - Alfred H Schinkel
- The Netherlands Cancer Institute, Division of Pharmacology, Amsterdam, The Netherlands.
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8
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Liang H, Lu Y, Huang X, Ye T. LncRNA BRCAT54 is downregulated and inhibits cancer cell proliferation by downregulating miR-130b-3p through methylation in prostate cancer. J Biochem Mol Toxicol 2024; 38:e23552. [PMID: 37888834 DOI: 10.1002/jbt.23552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/08/2023] [Accepted: 10/02/2023] [Indexed: 10/28/2023]
Abstract
BRCAT54 and miR-130b-3p are two recently characterized critical players in cancer biology, while their functions in prostate cancer (PC) are unknown. From preliminary sequencing analysis, we observed altered expression of BRCAT54 and miR-130b-3p in PC and an inverse correlation between them. This study was conducted to explore their involvement in PC. A total of 64 PC patients were enrolled to collect paired PC and nontumor tissues. The expression of BRCAT54 and miR-130b-3p were determined by RT-qPCR. Overexpression of BRCAT54 and miR-130b-3p was achieved in PC cells to explore their roles in regulating the expression of each other. Methylation-specific PCR (MSP) was conducted to explore the role of BRCAT54 in regulating promoter methylation of miR-130b-3p. BrdU assay was used to evaluate the role of BRCAT54 and miR-130b-3p in regulating PC cell proliferation. The results showed that PC tissues exhibited downregulation of BRCAT54 and upreglation of miR-130b-3p compared to that in nontumor tissues. They were inversely correlated across PC tissue samples. Overexpression of BRCAT54 decreased RNA accumulation of miR-130b-3p in PC cells. In addition, overexpression of BRCAT54 increased promoter methylation of miR-130b-3p. Moreover, BRCAT54 suppressed the role of miR-130b-3p in promoting PC cell proliferation. In conclusion, BRCAT54 is downregulated in PC and it may inhibit cancer cell proliferation by downregulating miR-130b-3p through methylation.
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Affiliation(s)
- Haote Liang
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yongyong Lu
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xixi Huang
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Tingyu Ye
- Department of Urology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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9
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Vanden Berg RNW, Zilli T, Achard V, Dorff T, Abern M. The diagnosis and treatment of castrate-sensitive oligometastatic prostate cancer: A review. Prostate Cancer Prostatic Dis 2023; 26:702-711. [PMID: 37422523 DOI: 10.1038/s41391-023-00688-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/06/2023] [Accepted: 06/21/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Oligometastatic prostate cancer (OMPCa) is emerging as a transitional disease state between localized and polymetastatic disease. This review will assess the current knowledge of castrate-sensitive OMPCa. METHODS A review of the current literature was performed to summarize the definition and classification of OMPCa, assess the diagnostic methods and imaging modalities utilized, and to review the treatment options and outcomes. We further identify gaps in knowledge and areas for future research. RESULTS Currently there is no unified definition of OMPCa. National guidelines mostly recommend systemic therapies without distinguishing oligometastatic and polymetastatic disease. Next generation imaging is more sensitive than conventional imaging and has led to early detection of metastases at initial diagnosis or recurrence. While mostly retrospective in nature, recent studies suggest that treatment (surgical or radiation) of the primary tumor and/or metastatic sites might delay initiation of androgen deprivation therapy while increasing survival in selected patients. CONCLUSIONS Prospective data are required to better assess the incremental improvement in survival and quality of life achieved with various treatment strategies in patients with OMPCa.
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Affiliation(s)
| | - Thomas Zilli
- Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), EOC, Bellinzona, Switzerland
- Faculty of Medicine, Università della Svizzera Italiana, Lugano, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Vérane Achard
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Radiation Oncology, HFR Fribourg, Villars-sur-Glâne, Switzerland
| | - Tanya Dorff
- City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Michael Abern
- Department of Urology, Duke University, Durham, NC, USA.
- Duke Cancer Institute, Durham, NC, USA.
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10
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Rayamajhi SJ, Ponisio MR, Siegel B. Use of 18 F-PSMA PET to Distinguish Cerebral Radiation Necrosis From Tumor Recurrence. Clin Nucl Med 2023; 48:e483-e484. [PMID: 37486317 DOI: 10.1097/rlu.0000000000004785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
ABSTRACT Brain metastasis in prostate adenocarcinoma is extremely rare and usually arises in the setting of widespread osseous and visceral metastases. Surgical resection and radiation therapy, including stereotactic radiosurgery, are the mainstays of treatment for brain metastasis. Radiation necrosis is a common complication of radiotherapy for brain metastasis, and distinguishing it from tumor recurrence by MRI is difficult because of overlapping findings. We present a 73-year-old man with prostate cancer with a solitary brain metastasis where PET with 18 F-piflufolostat helped detect disease recurrence in the setting of ambiguous MRI findings.
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Affiliation(s)
- Sampanna Jung Rayamajhi
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO
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11
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Rahnea-Nita RA, Rebegea LF, Nechifor A, Mareș C, Toma RV, Stoian AR, Ciuhu AN, Andronache LF, Constantin GB, Rahnea-Nita G. The Complexity of Treatments and the Multidisciplinary Team-A Rare Case of Long-Term Progression-Free Survival in Prostate Cancer until Development of Liver and Brain Metastases. J Clin Med 2023; 12:5579. [PMID: 37685646 PMCID: PMC10488423 DOI: 10.3390/jcm12175579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Prostate cancer has no initial clinical manifestation in the case of brain metastases since they are asymptomatic at first. This is why there is a high risk for clinicians to overlook these lesions, and they are often confused with other diseases. With all the improvements in diagnostic technological methods, which allow the early detection of lesions, and the progress in terms of systemic therapy associated with increased survival, an increase in incidence has also been noticed. MATERIALS AND METHODS We report the case of a 64-year-old patient who presented himself to the Oncology Department of "St. Luca" Chronic Disease Hospital in Bucharest in November 2011 and received the following diagnosis: biopsied prostate neoplasm, local-regionally advanced, pelvic lymph node metastases. RESULTS After receiving complex oncological treatment, this patient represents a rare case of long-term progression-free survival (15 years). DISCUSSIONS This case has some particularities. According to the literature data, survival with metastatic prostate cancer is approximately 21 months, and cerebral metastases are found in only 2% of prostate cancer cases. This case is one of the few cases in the specialty literature that benefited from all therapeutic sequences; namely, total androgenic blockade, docetaxel, abiraterone, enzalutamide, and cabazitaxel. CONCLUSIONS Brain metastases are an unfavorable prognostic factor in prostate cancer. The therapeutic options developed in recent years allow the improvement of survival.
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Affiliation(s)
- Roxana-Andreea Rahnea-Nita
- The Clinical Department, The Faculty of Medicine, The University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (R.-A.R.-N.); (C.M.); (R.-V.T.); (A.-R.S.); (L.-F.A.); (G.R.-N.)
- The Oncology-Palliative Care Department, “Sf. Luca” Chronic Disease Hospital, 041915 Bucharest, Romania;
| | - Laura-Florentina Rebegea
- The Radiotherapy Department, “Sf. Ap. Andrei” County Emergency Clinical Hospital, 800579 Galati, Romania;
- The Clinical Department, The Faculty of Medicine and Pharmacy, “Dunarea de Jos” University in Galati, 800008 Galati, Romania;
- The Research Center in the Field of Medical and Pharmaceutical Sciences, ReFORM-UDJ, 800010 Galati, Romania
| | - Alexandru Nechifor
- The Clinical Department, The Faculty of Medicine and Pharmacy, “Dunarea de Jos” University in Galati, 800008 Galati, Romania;
| | - Cristian Mareș
- The Clinical Department, The Faculty of Medicine, The University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (R.-A.R.-N.); (C.M.); (R.-V.T.); (A.-R.S.); (L.-F.A.); (G.R.-N.)
- The Urology Department, “Sf. Ioan” Emergency Clinical Hospital, 042122 Bucharest, Romania
| | - Radu-Valeriu Toma
- The Clinical Department, The Faculty of Medicine, The University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (R.-A.R.-N.); (C.M.); (R.-V.T.); (A.-R.S.); (L.-F.A.); (G.R.-N.)
- The Radiotherapy Department, The Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Alexandru-Rares Stoian
- The Clinical Department, The Faculty of Medicine, The University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (R.-A.R.-N.); (C.M.); (R.-V.T.); (A.-R.S.); (L.-F.A.); (G.R.-N.)
- The Surgery Department, “Bagdasar-Arseni” Emergency Clinical Hospital, 041915 Bucharest, Romania
| | - Anda-Natalia Ciuhu
- The Oncology-Palliative Care Department, “Sf. Luca” Chronic Disease Hospital, 041915 Bucharest, Romania;
| | - Liliana-Florina Andronache
- The Clinical Department, The Faculty of Medicine, The University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (R.-A.R.-N.); (C.M.); (R.-V.T.); (A.-R.S.); (L.-F.A.); (G.R.-N.)
| | - Georgiana Bianca Constantin
- The Morphological and Functional Sciences Department, The Faculty of Medicine and Pharmacy, “Dunarea de Jos” University in Galati, 800008 Galati, Romania
| | - Gabriela Rahnea-Nita
- The Clinical Department, The Faculty of Medicine, The University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (R.-A.R.-N.); (C.M.); (R.-V.T.); (A.-R.S.); (L.-F.A.); (G.R.-N.)
- The Oncology-Palliative Care Department, “Sf. Luca” Chronic Disease Hospital, 041915 Bucharest, Romania;
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12
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McLaughlin LA, Yildirim O, Rosenblum MK, Imber BS, Haseltine JM, Zelefsky MJ, Schöder H, Morris MJ, Rafelson WM, Krebs S, Moss NS. Identification of incidental brain tumors in prostate cancer patients via PSMA PET/CT. J Neurooncol 2023; 163:455-462. [PMID: 37247180 PMCID: PMC10746351 DOI: 10.1007/s11060-023-04355-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/24/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE Brain metastases are rare in patients with prostate cancer and portend poor outcome. Prostate-specific membrane antigen positron emission tomography (PSMA PET)/CT scans including the brain have identified incidental tumors. We sought to identify the incidental brain tumor detection rate of PSMA PET/CT performed at initial diagnosis or in the setting of biochemical recurrence. METHODS An institutional database was queried for patients who underwent 68Ga-PSMA-11 or 18F-DCFPyL (18F-piflufolastat) PET/CT imaging at an NCI-designated Comprehensive Cancer Center from 1/2018 to 12/2022. Imaging reports and clinical courses were reviewed to identify brain lesions and describe clinical and pathologic features. RESULTS Two-thousand seven hundred and sixty-three patients underwent 3363 PSMA PET/CT scans in the absence of neurologic symptoms. Forty-four brain lesions were identified, including 33 PSMA-avid lesions: 10 intraparenchymal metastases (30%), 4 dural-based metastases (12%), 16 meningiomas (48%), 2 pituitary macroadenomas (6%), and 1 epidermal inclusion cyst (3%) (incidences of 0.36, 0.14, 0.58, 0.07, and 0.04%). The mean parenchymal metastasis diameter and mean SUVmax were 1.99 cm (95%CI:1.25-2.73) and 4.49 (95%CI:2.41-6.57), respectively. At the time of parenchymal brain metastasis detection, 57% of patients had no concurrent extracranial disease, 14% had localized prostate disease only, and 29% had extracranial metastases. Seven of 8 patients with parenchymal brain metastases remain alive at a median 8.8 months follow-up. CONCLUSION Prostate cancer brain metastases are rare, especially in the absence of widespread metastatic disease. Nevertheless, incidentally detected brain foci of PSMA uptake may represent previously unknown prostate cancer metastases, even in small lesions and in the absence of systemic disease.
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Affiliation(s)
- Lily A McLaughlin
- Georgetown University School of Medicine, Washington, DC, USA
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Onur Yildirim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc K Rosenblum
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brandon S Imber
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Multidisciplinary Brain Metastasis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Justin M Haseltine
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael J Morris
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William M Rafelson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Simone Krebs
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nelson S Moss
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Multidisciplinary Brain Metastasis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Neurosurgery and Brain Metastasis Center, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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13
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Ajit N, Tejonath G, Pratyusha B, Zakir AA. Rare Isolated Cerebellar Metastases in Prostate Cancer: A Case Report with Review of Literature. World J Nucl Med 2023; 22:140-143. [PMID: 37223626 PMCID: PMC10202584 DOI: 10.1055/s-0043-1768449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Prostate cancer is a common malignancy affecting elderly males. Generally, prostate cancer metastases to lymph nodes and skeletal lesions. Brain metastasis from prostate cancer is an uncommon phenomenon. When occurs, it affects the liver and lungs. Less than 1% of the cases show brain metastases, with isolated brain metastases being even more rare. We present the case of a 67-year-old male patient who was diagnosed to have prostate carcinoma and maintained on hormonal therapy. Later, the patient presented with raising serum-68 prostate-specific antigen (PSA) levels. Gallium-68 prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) scan revealed isolated cerebellar metastasis. He was later treated with whole brain radiotherapy.
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Affiliation(s)
- Nimmagadda Ajit
- Department of Nuclear Medicine, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Gadepalli Tejonath
- Department of Nuclear Medicine, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Bikkina Pratyusha
- Department of Nuclear Medicine, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Abubacker Ali Zakir
- Department of Nuclear Medicine, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
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14
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Jang A, Jaeger EB, Ledet EM, Xie J, Lewis BE, Layton JL, Sartor O, Barata PC, Trevino CR. Clinical and Genetic Analysis of Metastatic Prostate Cancer to the Central Nervous System: A Single-Institution Retrospective Experience. Clin Genitourin Cancer 2023; 21:e9-e18. [PMID: 36376168 DOI: 10.1016/j.clgc.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/11/2022] [Accepted: 10/15/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Prostate cancer (PC) rarely metastasizes to the central nervous system (CNS). In this retrospective single-institution study at a tertiary cancer center, we aimed to evaluate the clinical and genetic characteristics of advanced PC patients with CNS metastases. PATIENTS AND METHODS Between January 2010 and March 2020, 12 out of 579 patients with extracranial metastatic PC were identified to have CNS metastases based on imaging, including six patients with brain metastases (BMs), five patients with dural metastases, and one unknown. These patients were followed up through March 2022. Clinical data were compared to the overall cohort of patients evaluated at our cancer center during that decade. Genetics information was also analyzed for the patients with available data via cell-free DNA (cfDNA) blood samples. RESULTS Median time from development of extracranial metastatic disease to development of CNS metastases was 5.5 years (95% CI, 1.8-7.0). Median overall survival (mOS) from diagnosis of CNS metastases was 6.1 months (95% CI, 5.8-8.2). Notably, there was no significant difference in mOS after development of extracranial metastases in patients with CNS metastases (6.4 years; 95% CI, 4.6-7.9) compared to the patients without known CNS metastases (5.2 years; 95% CI, 4.6-5.7) (P = .91). For the cohort with CNS metastases, nine patients had germline testing and seven patients had somatic testing via cfDNA. CONCLUSION PC patients with CNS metastases did not often die from a neurological cause. With advancing therapies, the overall prognosis of metastatic PC continues to improve, and CNS metastases will become more common.
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Affiliation(s)
- Albert Jang
- Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Ellen B Jaeger
- Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Elisa M Ledet
- Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - John Xie
- Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Brian E Lewis
- Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Jodi L Layton
- Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Oliver Sartor
- Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Pedro C Barata
- Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Christopher R Trevino
- Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA.
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15
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Mirmoeeni S, Azari Jafari A, Shah M, Salemi F, Hashemi SZ, Seifi A. The Clinical, Diagnostic, Therapeutic, and Prognostic Characteristics of Brain Metastases in Prostate Cancer: A Systematic Review. Prostate Cancer 2022; 2022:5324600. [PMID: 36474619 PMCID: PMC9719815 DOI: 10.1155/2022/5324600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 08/19/2023] Open
Abstract
AIM Prostate cancer (PCa) is the second most common nonskin malignancy and the second most common cause of cancer-related deaths in men. The most common site of metastasis in PCa is the axial skeleton which may lead to back pain or pathological fractures. Hematogenous spread to the brain and involvement of the central nervous system (CNS) are a rare occurrence. However, failed androgen deprivation therapy (ADT) may facilitate such a spread resulting in an advanced metastatic stage of PCa, which carries a poor prognosis. METHODS In this systematic review, we searched the PubMed, Scopus, and Web of Science online databases based on the PRISMA guideline and used all the medical subject headings (MeSH) in terms of the following search line: ("Brain Neoplasms" OR "Central Nervous System Neoplasms") and ("Prostatic Neoplasms" OR "Prostate"). Related studies were identified and reviewed. RESULTS A total of 59 eligible studies (902 patients) were included in this systematic review. In order to gain a deeper understanding, we extracted and presented the data from included articles based on clinical manifestations, diagnostic methods, therapeutic approaches, and prognostic status of PCa patients having BMs. CONCLUSION We have demonstrated the current knowledge regarding the mechanism, clinical manifestations, diagnostic methods, therapeutic approaches, and prognosis of BMs in PCa. These data shed more light on the way to help clinicians and physicians to understand, diagnose, and manage BMs in PCa patients better.
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Affiliation(s)
| | | | - Muffaqam Shah
- Deccan College of Medical Sciences, P.O. Kanchanbagh, DMRL ‘X' Road, Santhosh Nagar, Hyderabad 500058, Telangana, India
| | - Fateme Salemi
- School of Medicine, Islamic Azad University of Medical Sciences, Yazd, Iran
| | - Seyedeh Zohreh Hashemi
- Researcher at the Research Center of Tehran University of Medical Sciences, Pharmacology Department, Tehran, Iran
| | - Ali Seifi
- Department of Neurosurgery, Division of Neuro Critical Care, University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, TX, USA
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16
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Ma QF, Ou CY, Wang QH, Wang YN. Incidental finding of metastatic prostatic adenocarcinoma of cerebellopontine angle presenting as acoustic neuroma: A case report and review of literature. Int J Surg Case Rep 2022; 98:107493. [PMID: 35969908 PMCID: PMC9399265 DOI: 10.1016/j.ijscr.2022.107493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/31/2022] [Accepted: 08/06/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Qing-Fang Ma
- Department of Neurosurgery, Xu Zhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Chun-Ying Ou
- Department of Neurology, Xu Zhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Qi-Hong Wang
- Department of Neurosurgery, Xu Zhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Yong-Nan Wang
- Department of Neurosurgery, Xu Zhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China.
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17
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Rajeswaran K, Muzio K, Briones J, Lim-Fat MJ, Tseng CL, Smoragiewicz M, Detsky J, Emmenegger U. Prostate Cancer Brain Metastasis: Review of a Rare Complication with Limited Treatment Options and Poor Prognosis. J Clin Med 2022; 11:jcm11144165. [PMID: 35887929 PMCID: PMC9323816 DOI: 10.3390/jcm11144165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/06/2022] [Accepted: 07/12/2022] [Indexed: 02/04/2023] Open
Abstract
Brain metastases (BM) are perceived as a rare complication of prostate cancer associated with poor outcome. Due to limited published data, we conducted a literature review regarding incidence, clinical characteristics, treatment options, and outcomes of patients with prostate cancer BM. A literature analysis of the PubMed, MEDLINE, and EMBASE databases was performed for full-text published articles on patients diagnosed with BM from prostate cancer. Eligible studies included four or more patients. Twenty-seven publications were selected and analyzed. The sources of published patient cohorts were retrospective chart reviews, administrative healthcare databases, autopsy records, and case series. BM are rare, with an incidence of 1.14% across publications that mainly focus on intraparenchymal metastases. Synchronous visceral metastasis and rare histological prostate cancer subtypes are associated with an increased rate of BM. Many patients do not receive brain metastasis-directed local therapy and the median survival after BM diagnosis is poor, notably in patients with multiple BM, dural-based metastases, or leptomeningeal dissemination. Overall, prostate cancer BM are rare and associated with poor prognosis. Future research is needed to study the impact of novel prostate cancer therapeutics on BM incidence, to identify patients at risk of BM, and to characterize molecular treatment targets.
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Affiliation(s)
- Kobisha Rajeswaran
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; (K.R.); (K.M.); (M.S.)
| | - Kaitlin Muzio
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; (K.R.); (K.M.); (M.S.)
| | - Juan Briones
- Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Católica de Chile, 309 Diagonal Paraguay, Santiago 8330077, Chile;
| | - Mary Jane Lim-Fat
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada;
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; (C.-L.T.); (J.D.)
| | - Martin Smoragiewicz
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; (K.R.); (K.M.); (M.S.)
- Department of Medicine, University of Toronto, 1 King’s College Cir, Toronto, ON M5S 1A8, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; (C.-L.T.); (J.D.)
| | - Urban Emmenegger
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; (K.R.); (K.M.); (M.S.)
- Department of Medicine, University of Toronto, 1 King’s College Cir, Toronto, ON M5S 1A8, Canada
- Biological Sciences Research Platform, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
- Institute of Medical Science, University of Toronto, 1 King’s College Cir, Toronto, ON M5S 1A8, Canada
- Correspondence: ; Tel.: +1-416-480-4928; Fax: +1-416-480-6002
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18
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Kang J, La Manna F, Bonollo F, Sampson N, Alberts IL, Mingels C, Afshar-Oromieh A, Thalmann GN, Karkampouna S. Tumor microenvironment mechanisms and bone metastatic disease progression of prostate cancer. Cancer Lett 2022; 530:156-169. [PMID: 35051532 DOI: 10.1016/j.canlet.2022.01.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 01/02/2022] [Accepted: 01/13/2022] [Indexed: 12/14/2022]
Abstract
During disease progression from primary towards metastatic prostate cancer (PCa), and in particular bone metastases, the tumor microenvironment (TME) evolves in parallel with the cancer clones, altering extracellular matrix composition (ECM), vasculature architecture, and recruiting specialized tumor-supporting cells that favor tumor spread and colonization at distant sites. We introduce the clinical profile of advanced metastatic PCa in terms of common genetic alterations. Findings from recently developed models of PCa metastatic spread are discussed, focusing mainly on the role of the TME (mainly matrix and fibroblast cell types), at distinct stages: premetastatic niche orchestrated by the primary tumor towards the metastatic site and bone metastasis. We report evidence of premetastatic niche formation, such as the mechanisms of distant site conditioning by extracellular vesicles, chemokines and other tumor-derived mechanisms, including altered cancer cell-ECM interactions. Furthermore, evidence supporting the similarities of stroma alterations among the primary PCa and bone metastasis, and contribution of TME to androgen deprivation therapy resistance are also discussed. We summarize the available bone metastasis transgenic mouse models of PCa from a perspective of pro-metastatic TME alterations during disease progression and give an update on the current diagnostic and therapeutic radiological strategies for bone metastasis clinical management.
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Affiliation(s)
- Juening Kang
- Department for BioMedical Research, Urology Research Laboratory, University of Bern, Bern, Switzerland
| | - Federico La Manna
- Department for BioMedical Research, Urology Research Laboratory, University of Bern, Bern, Switzerland
| | - Francesco Bonollo
- Department for BioMedical Research, Urology Research Laboratory, University of Bern, Bern, Switzerland
| | - Natalie Sampson
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ian L Alberts
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Clemens Mingels
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ali Afshar-Oromieh
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - George N Thalmann
- Department for BioMedical Research, Urology Research Laboratory, University of Bern, Bern, Switzerland; Department of Urology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Sofia Karkampouna
- Department for BioMedical Research, Urology Research Laboratory, University of Bern, Bern, Switzerland.
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Cardinal T, Pangal D, Strickland BA, Newton P, Mahmoodifar S, Mason J, Craig D, Simon T, Tew BY, Yu M, Yang W, Chang E, Cabeen RP, Ruzevick J, Toga AW, Neman J, Salhia B, Zada G. Anatomical and topographical variations in the distribution of brain metastases based on primary cancer origin and molecular subtypes: a systematic review. Neurooncol Adv 2022; 4:vdab170. [PMID: 35024611 PMCID: PMC8739649 DOI: 10.1093/noajnl/vdab170] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background While it has been suspected that different primary cancers have varying predilections for metastasis in certain brain regions, recent advances in neuroimaging and spatial modeling analytics have facilitated further exploration into this field. Methods A systematic electronic database search for studies analyzing the distribution of brain metastases (BMs) from any primary systematic cancer published between January 1990 and July 2020 was conducted using PRISMA guidelines. Results Two authors independently reviewed 1957 abstracts, 46 of which underwent full-text analysis. A third author arbitrated both lists; 13 studies met inclusion/exclusion criteria. All were retrospective single- or multi-institution database reviews analyzing over 8227 BMs from 2599 patients with breast (8 studies), lung (7 studies), melanoma (5 studies), gastrointestinal (4 studies), renal (3 studies), and prostate (1 study) cancers. Breast, lung, and colorectal cancers tended to metastasize to more posterior/caudal topographic and vascular neuroanatomical regions, particularly the cerebellum, with notable differences based on subtype and receptor expression. HER-2-positive breast cancers were less likely to arise in the frontal lobes or subcortical region, while ER-positive and PR-positive breast metastases were less likely to arise in the occipital lobe or cerebellum. BM from lung adenocarcinoma tended to arise in the frontal lobes and squamous cell carcinoma in the cerebellum. Melanoma metastasized more to the frontal and temporal lobes. Conclusion The observed topographical distribution of BM likely develops based on primary cancer type, molecular subtype, and genetic profile. Further studies analyzing this association and relationships to vascular distribution are merited to potentially improve patient treatment and outcomes.
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Affiliation(s)
- Tyler Cardinal
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Dhiraj Pangal
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Ben A Strickland
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Paul Newton
- Department of Aerospace and Mechanical Engineering, Mathematics and The Ellison Institute for Transformative Medicine of USC, Los Angeles, California, USA
| | - Saeedeh Mahmoodifar
- Department of Physics & Astronomy, University of Southern California, Los Angeles, California, USA
| | - Jeremy Mason
- Department of Urology, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - David Craig
- Department of Translational Genomics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Thomas Simon
- Department of Translational Genomics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Ben Yi Tew
- Department of Translational Genomics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Min Yu
- Broad Stem Cell Center, University of Southern California, Los Angeles, California, USA
| | - Wensha Yang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
| | - Eric Chang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
| | - Ryan P Cabeen
- USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, California, USA
| | - Jacob Ruzevick
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Arthur W Toga
- USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, California, USA
| | - Josh Neman
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Bodour Salhia
- Department of Translational Genomics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Gabriel Zada
- Department of Neurosurgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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20
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Jain A, Nayan A, Patwardhan S. Blindness paving the path to the diagnosis of metastatic prostate carcinoma: A unique case presentation. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211053701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Intracranial metastases from prostate adenocarcinoma are very unusual and typically occur late in the course of the disease, and initial presentation with symptomatic brain involvement, especially vision loss is very rare (with this being only the sixth such reported case to the best of our knowledge). The present case elucidates how a diagnosis was reached in such a scenario and the management provided. Case presentation: A 66-year-old gentleman presented with loss of vision and headache with no other ocular or neurological complaint. Computed tomography (CT) of his head revealed a destructive lesion involving the clivus and a space-occupying lesion (SOL) in occipito-parietal region. Detailed inquiry regarding the possible primary source of suspected the metastatic lesion revealed an increased frequency of urination, nocturia, and significant weight loss. His serum prostate-specific antigen (PSA) levels were raised. He was treated by surgical hormonal therapy and his visual symptoms improved. Conclusion: Awareness of such a presentation can lead to an accurate diagnosis. Initiation of appropriate therapy can successfully alleviate the neurologic deficits.
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Affiliation(s)
- Aadhar Jain
- Department of Urology, Seth GS Medical College and KEM Hospital, Maharashtra University of Health Sciences, India
| | - Anveshi Nayan
- Seth GS Medical College, Maharashtra University of Health Sciences, India
| | - Sujata Patwardhan
- Department of Urology, Seth GS Medical College and KEM Hospital, Maharashtra University of Health Sciences, India
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21
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Al-Salihi MM, Al-Jebur MS, Lozada-Martinez ID, Rahman MM, Rahman S. Brain metastasis from prostate cancer: A review of the literature with an illustrative case. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Porcar Plana CA, Puzo Bayod M, Santos Alarcón S, Moya Roca J, Campos Mollo E. Proptosis and a Dermal Lesion as the Presenting Sign of Lung Adenocarcinoma. Case Rep Ophthalmol 2021; 12:729-733. [PMID: 34720970 PMCID: PMC8460890 DOI: 10.1159/000515270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/14/2021] [Indexed: 11/19/2022] Open
Abstract
The purpose is to describe a clinical case of orbital metastases as the presentation sign of the primary tumor, and the importance of a multidisciplinary diagnosis. A 70-year-old man attended the Ophthalmology Department referring ocular pain. Mild proptosis and a dermal lesion in the neck were noticed. Biopsy of the dermal lesion and systemic work-up were compatible with lung adenocarcinoma with metastatic dissemination. After one cycle of palliative chemotherapy, patient's medical condition worsened, and he eventually died. Although rare, orbital symptoms can be the initial clinical presentation preceding the diagnosis of the primary silent lung neoplasm. Ophthalmologist has an important role in diagnoses of metastatic orbital cancer. Involvement of the multidisciplinary team is important for diagnosis and treatment.
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Affiliation(s)
| | - Martín Puzo Bayod
- Ophthalmology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Jaime Moya Roca
- Ophthalmology Department, Hospital Virgen de los Lirios, Alcoy, Spain
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23
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Viglialoro R, Esposito E, Zanca R, Gessi M, Depalo T, Aghakhanyan G, Bartoli F, Sollini M, Erba PA. What to Trust, PSA or [ 68Ga]Ga-PSMA-11: Learn from Experience. Res Rep Urol 2021; 13:597-601. [PMID: 34447724 PMCID: PMC8384575 DOI: 10.2147/rru.s316446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/09/2021] [Indexed: 11/23/2022] Open
Abstract
Brain metastases from prostate cancer typically occur in the more advanced stages of the disease. Clinically, the early diagnosis of visceral disease is crucial, impacting on patient’s management and prognosis. Although magnetic resonance imaging (MRI) is the modality of choice for the detection of brain metastases, it is not routinely performed in the surveillance of prostate cancer patients unless neurological manifestations appear. Prostate-specific membrane antigen (PSMA) is a glycoprotein, a membrane-bound metallopeptidase, overexpressed in more than 90% of prostate cancer cells. This molecular target is a suitable tissue biomarker for prostate cancer functional imaging. We present a case of a 73-year gentleman diagnosed with prostate adenocarcinoma and surgically treated (pT3bN1Mx, Gleason Score of 9) in February 2016. Subsequently, he underwent androgen deprivation therapy because of the occurrence of a bone metastasis. Between 2016 and January 2019 PSA levels were maintained under control. Starting from September 2019, it progressively raised up to 0.85 ng/mL with a doubling time of 3.3 months. Therefore, he performed a [68Ga]Ga-PSMA-11 PET/CT which showed a focal radiopharmaceutical uptake in the right temporal lobe corresponding to the presence of a rounded cystic lesion on brain MRI. The subsequent excisional biopsy diagnosed a prostate adenocarcinoma metastasis. PSMA expression has been reported in brain parenchyma after ischemic strokes and in some brain tumors including gliomas, meningiomas, and neurofibromas. In our case, the lack of symptoms and the relatively low PSA level raised questions about the nature of the lesion, posing the differential diagnosis between brain metastases and primary brain tumor. Finally, our case shows the capability of [68Ga]Ga-PSMA-11 PET/CT to detect metachronous distant brain metastases in a low biochemical recurrent asymptomatic prostate cancer patient, indicating that proper acquisition – from the vertex to thigh – should be always considered, regardless of the PSA level.
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Affiliation(s)
- Rita Viglialoro
- Regional Center of Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy.,Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Enrica Esposito
- Regional Center of Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy.,Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Roberta Zanca
- Regional Center of Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy.,Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Marco Gessi
- Neuropathology Unit, Division of Pathology Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Tommaso Depalo
- Regional Center of Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy.,Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Gayane Aghakhanyan
- Regional Center of Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy.,Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Francesco Bartoli
- Regional Center of Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy.,Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Martina Sollini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Paola Anna Erba
- Regional Center of Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy.,Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Centre, University Medical Center Groningen, Groningen, the Netherlands
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24
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A solitary hypothalamic metastasis from prostatic cancer mimicking a giant thrombotic aneurysm and presenting with intraventricular hemorrhage and acute hydrocephalus: a case report. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [PMCID: PMC7729140 DOI: 10.1186/s43055-020-00367-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Despite the high prevalence of prostate cancer, its brain parenchymal metastasis is not common and intracranial hemorrhage due to such a metastasis is even less common. This report presents a challenging case of solitary brain metastasis secondary to prostate cancer that gave rise to intraventricular hemorrhage and acute hydrocephalus mimicking a giant aneurysm. Case presentation A 77-year-old man with a history of prostate cancer, hypertension, and morbid obesity presented to the emergency room with a severe headache. He was afebrile with a blood pressure of 144/79 mmHg, alert, without any sign of sensory or motor deficit. Shortly after admission, he became unresponsive and was immediately intubated. His blood tests revealed hypernatremia at 154 mmol/L; otherwise, the lab data including the COVID-19 screening proved normal. The cerebral CT and MR images, with and without contrast, were interpreted as a giant thrombotic aneurysm extending to the suprasellar region by the emergency radiologist. Also, moderate intraventricular hemorrhage, acute hydrocephalus, and sub-ependymal interstitial edema were observed. Upon further evaluation of the images, the lesion was determined to be an exophytic hemorrhagic hypothalamic mass, and the subsequent biopsy was consistent with prostate cancer metastasis. Conclusions The exophytic hemorrhagic hypothalamic metastasis can mimic a ruptured aneurysm on imaging. Given the improved survival of patients with prostate cancer, radiologists may encounter such unusual cerebral metastases from prostate cancers more frequently in the future.
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