1
|
Kaplan İ, Kömek H, Can C, Akdeniz N, Güzel Y, Kepenek F, Şenol A, İleri S, Karaoğlan H, Solmaz İ, Yıldırım MS, Şenses V, Kaya F, Gündoğan C. Should new organ involvement be included in Response Evaluation Criteria in PSMA Imaging? Ann Nucl Med 2024:10.1007/s12149-024-01954-0. [PMID: 38880859 DOI: 10.1007/s12149-024-01954-0] [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: 01/16/2024] [Accepted: 06/11/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE The current study is intended to investigate the effect of new organ involvement on overall survival (OS) and modify the Response Evaluation Criteria in PSMA Imaging (RECIP) by including new organ involvement to RECIP 1.0. MATERIALS AND METHODS This retrospective study includes 114 patients diagnosed with metastatic castration-resistant prostate cancer (mCRPC) between September 2017 and June 2022 who had received docetaxel treatment and had baseline and post-treatment prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) images. The inclusion criteria were patients with pre- and post-treatment [18F]FDG PET/CT images and whose [18F]FDG PET images were negative. Those whose data were unavailable, who had additional malignancy, or who received abiraterone, enzalutamide, or Lutetium (Lu)-177 treatment were excluded. Age, Gleason score (GS), TPSA (total prostate-specific antigen) levels, surgical history, and OS information were recorded for each patient. RESULTS The 114 patients herein had a median age of 72.5 (51-91) years and a median GS of 8 (7-10). New lesions were observed in 59 patients (51.7%) and new organ PSMA uptake was observed in 14 patients (12.2%). In the multivariate Cox regression analysis, volume-based treatment response (vTR)-total lesion PSMA (TLP), RECIP PSMA-VOL, modified RECIP (mRECIP) PSMA-VOL, and mRECIP TLP were independent prognostic factors for mortality (p < 0.001, p = 0.006, p = 0.003, and p = 0.003, respectively). The median OS of patients with new organ involvement and new lesion with PSMA uptake was 9.3 months (95% CI 2.1-16.5 months) and 11.8 months (95% CI 7.4-16.2 months), respectively. CONCLUSION The study concluded that new organ involvement had a shorter OS than new lesion involvement. In the mRECIP that we developed, unlike RECIP, we demonstrated that both PSMA-VOL and TLP value were independent prognostic factors for mortality.
Collapse
Affiliation(s)
- İhsan Kaplan
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey.
| | - Halil Kömek
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
| | - Canan Can
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
| | - Nadiye Akdeniz
- Department of Internal Medicine, Division of Medical Oncology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Yunus Güzel
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
| | - Ferat Kepenek
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
| | - Ayhan Şenol
- Department of Radiology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Serdar İleri
- Department of Internal Medicine, Division of Medical Oncology, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Hüseyin Karaoğlan
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
| | - İhsan Solmaz
- Department of Internal Medicine, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Mehmet Serdar Yıldırım
- Department of Internal Medicine, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Veysi Şenses
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
| | - Fulya Kaya
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
| | - Cihan Gündoğan
- Department of Nuclear Medicine, Gazi Yasargil Training and Research Hospital, 21070, Kayapınar, Diyarbakir, Turkey
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Aggarwal P, Sood A, Kumar R, Singh H, Singh H, Bhatia V, Mittal BR. Unusual Sites of Visceral Spread in Prostate Cancer: A Prostate-Specific Membrane Antigen-Based Theranostic Imaging Series. Clin Nucl Med 2024; 49:e222-e226. [PMID: 38465933 DOI: 10.1097/rlu.0000000000005118] [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: 03/12/2024]
Abstract
ABSTRACT Prostate cancer commonly metastasizes to lymphatic and skeletal systems with lesser frequency to visceral organs; however, uncommon visceral sites have also been found and reported as case reports. We present a series of uncommon metastatic visceral spread in prostate cancer on prostate-specific membrane antigen-based diagnostic and posttherapeutic imaging modalities.
Collapse
Affiliation(s)
| | | | | | | | | | - Vikas Bhatia
- Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Ebrahimi H, Castro DV, Feng MI, Prajapati SR, Lee KO, Chan EH, Paul T, Sehgal I, Patel J, Li X, Zengin ZB, Meza L, Mercier BD, Hsu J, Govindarajan A, Chawla N, Dizman N, Bergerot CD, Rock A, Liu S, Tripathi A, Dorff T, Pal SK, Chehrazi-Raffle A. Examining Exclusion Criteria in Advanced Prostate Cancer Clinical Trials: An Assessment of recommendations From the American Society Of Clinical Oncology and Friends of Cancer Research. Clin Genitourin Cancer 2023; 21:e467-e473. [PMID: 37301665 DOI: 10.1016/j.clgc.2023.05.013] [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: 04/14/2023] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Eligibility criteria illustrate the characteristics of the study population and promote the safety of participants. However, overreliance on restrictive eligibility criteria may limit the generalizability of outcomes. As a result, the American Society of Clinical Oncology (ASCO) and Friends of Cancer Research (Friends) issued statements to curtail these challenges. In this study, we aimed to assess restrictiveness in eligibility criteria across advanced prostate cancer clinical trials. MATERIALS AND METHODS We identified all phase I, II, and III advanced prostate cancer clinical trials between June 30, 2012, and June 30, 2022, through Clinicaltrials.gov. We evaluated whether a clinical trial excluded, conditionally included, or did not report 4 common criteria: brain metastases, prior or concurrent malignancies, HIV infection, and hepatitis B virus (HBV)/hepatitis C virus (HCV) infection. Performance status (PS) criteria were recorded based on the Eastern Cooperative Oncology Group (ECOG) scale. RESULTS Out of 699 clinical trials within our search strategy, 265 (37.9%) trials possessed all the required data and were included in our analysis. The most common excluded condition of our interest was brain metastases (60.8%), followed by HIV positivity (46.4%), HBV/HCV positivity (46.0%), and concurrent malignancies (15.5%). Additionally, 50.9% of clinical trials only included patients with ECOG PS 0 to 1. HIV and HBV/HCV infection were exclusion criteria of 22 (80.8%) and 19 (73.1%) immunotherapy trials, respectively. CONCLUSION Patients with brain metastases, prior or concurrent malignancies, HIV infection, HBV/HCV infection, or low-functioning PS were overly restricted from participating in advanced prostate clinical trials. Advocating for broader criteria may ameliorate generalizability.
Collapse
Affiliation(s)
- Hedyeh Ebrahimi
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Daniela V Castro
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Matthew I Feng
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Sweta R Prajapati
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Kyle O Lee
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Elyse H Chan
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Trishita Paul
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Ishaan Sehgal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Jalen Patel
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Xiaochan Li
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Zeynep B Zengin
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Luis Meza
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Benjamin D Mercier
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - JoAnn Hsu
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Ameish Govindarajan
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Neal Chawla
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Nazli Dizman
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA; Department of Internal Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT
| | - Cristiane D Bergerot
- Centro de Câncer de Brasília (CETTRO), Instituto Unity de Ensino e Pesquisa, Brasília, Brazil
| | - Adam Rock
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Sandy Liu
- Department of Medical Oncology, City of Hope Orange County Medical Center, Irvine, CA
| | - Abhishek Tripathi
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Tanya Dorff
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Sumanta K Pal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Alexander Chehrazi-Raffle
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, CA.
| |
Collapse
|
7
|
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.
Collapse
Affiliation(s)
- Sampanna Jung Rayamajhi
- From the Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO
| | | | | |
Collapse
|
8
|
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.
Collapse
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;
| |
Collapse
|
9
|
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.
Collapse
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.
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Maslakova AA, Golyshev SA, Potashnikova DM, Moisenovich AM, Orlovsky IV, Smirnova OV, Rubtsov MA. SERPINA1 long transcripts produce non-secretory alpha1-antitrypsin isoform: In vitro translation in living cells. Int J Biol Macromol 2023; 241:124433. [PMID: 37086761 DOI: 10.1016/j.ijbiomac.2023.124433] [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: 01/21/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/24/2023]
Abstract
SERPINA1 is a well-studied serpin gene due to its dramatic impact on human health. Translation initiation at the main SERPINA1 start codon produces the only known alpha1-antitrypsin (AAT) isoform intended for secretion. AAT performs essential functions by inhibiting proteases and modulating immunity. However, SERPINA1 expression at the level of translation is not sufficiently studied. Here we hypothesize that the main SERPINA1 ORF can be alternatively translated, producing a non-secretory AAT isoform by either masking or excluding a signal peptide. We defined SERPINA1 long mRNA isoforms specific for prostate (DU145) and liver (HepG2) cell lines and studied their individual expression by in vitro assay. We found that all long transcripts produce both glycosylated secretory AAT-eGFP fusion protein and non-glycosylated intracellular AAT-eGFP (initiated from an alternative AUG-2 start codon), with the proportion regulated by the SERPINA1 5'-UTR. Both fusion proteins localize to distinct cellular compartments: in contrast to a fusion with the secretory AAT accumulating in the ER, the intracellular one exhibits nuclear-cytoplasmic shuttling. We detected putative endogenous AAT isoform enriching the nuclear speckles. CONCLUSION: Alternative translation initiation might be a mechanism through which SERPINA1 expands the biological diversity of its protein products. Our findings open up new prospects for the study of SERPINA1 gene expression.
Collapse
Affiliation(s)
- A A Maslakova
- Faculty of Biology, M.V. Lomonosov Moscow State University, Leninskie Gory, Moscow 119991, Russia.
| | - S A Golyshev
- A.N. Belozersky Institute of Physical and Chemical Biology, M.V. Lomonosov Moscow State University, Leninskie Gory, Moscow 119992, Russia
| | - D M Potashnikova
- Faculty of Biology, M.V. Lomonosov Moscow State University, Leninskie Gory, Moscow 119991, Russia
| | - A M Moisenovich
- Faculty of Biology, M.V. Lomonosov Moscow State University, Leninskie Gory, Moscow 119991, Russia
| | - I V Orlovsky
- Research Institute of Molecular and Cellular Medicine, Рeoples' Friendship University of Russia (RUDN University), Miklukho-Maklaya, Moscow 117198, Russia
| | - O V Smirnova
- Faculty of Biology, M.V. Lomonosov Moscow State University, Leninskie Gory, Moscow 119991, Russia
| | - M A Rubtsov
- Faculty of Biology, M.V. Lomonosov Moscow State University, Leninskie Gory, Moscow 119991, Russia; Center for Industrial Technologies and Entrepreneurship, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya, Moscow 119991, Russia
| |
Collapse
|
12
|
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.
Collapse
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.
| |
Collapse
|
13
|
Broderick A, Labriola MK, Shore N, Armstrong AJ. Foreign accent syndrome as a heralding manifestation of transformation to small cell neuroendocrine prostate cancer. BMJ Case Rep 2023; 16:e251655. [PMID: 36717160 PMCID: PMC9887694 DOI: 10.1136/bcr-2022-251655] [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] [Indexed: 01/31/2023] Open
Abstract
A man in his 50s with metastatic hormone-sensitive prostate cancer, receiving androgen deprivation therapy and abiraterone acetate/prednisone, presented with an uncontrollable 'Irish brogue' accent despite no Irish background, consistent with foreign accent syndrome (FAS). He had no neurological examination abnormalities, psychiatric history or MRI of the brain abnormalities at symptom onset. Imaging revealed progression of his prostate cancer, despite undetectable prostate-specific antigen levels. Biopsy confirmed transformation to small cell neuroendocrine prostate cancer (NEPC). Despite chemotherapy, his NEPC progressed resulting in multifocal brain metastases and a likely paraneoplastic ascending paralysis leading to his death. We report FAS as the presenting manifestation of transformation to small cell NEPC, a previously undescribed phenomenon. His presentation was most consistent with an underlying paraneoplastic neurological disorder (PND), despite a negative serum paraneoplastic panel. This report enhances the minimal existing literature on FAS and PNDs associated with transformed NEPC.
Collapse
Affiliation(s)
- Amanda Broderick
- Department of Internal Medicine, Duke University Health System, Durham, North Carolina, USA
| | - Matthew K Labriola
- Division of Medical Oncology, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Neal Shore
- Carolina Urologic Research Center, Myrtle Beach, South Carolina, USA
| | - Andrew J Armstrong
- Divisions of Medical Oncology and Urology, Duke Cancer Institute Center for Prostate and Urologic Cancers, Duke University, Durham, North Carolina, USA
| |
Collapse
|
14
|
Bandaru SK, Adhikari B, Ribeiro M, Paudel A. Metastatic adenocarcinoma of the prostate presenting as a solitary cystic brain mass. Radiol Case Rep 2022; 17:4652-4655. [PMID: 36204415 PMCID: PMC9530483 DOI: 10.1016/j.radcr.2022.09.050] [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: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 11/25/2022] Open
Abstract
Carcinoma prostate is the second most common cancer in men after skin cancer. It is the most common visceral malignancy in the United States of America. Like any other cancerous lesion, it has the propensity to metastasize to any part of the body; the most common locations being bones, lymph nodes, liver, and thoracic organs. However, it rarely metastasizes to the brain. It is even rarer for brain metastases to manifest as cystic lesions. We describe an unusual case of a metastatic prostate carcinoma presenting as a cystic brain mass.
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Mütevelizade G, Sezgin C, Gümüşer G, Sayit E. Unexpected Metastatic Localizations of Prostate Cancer Determined by 68Ga PSMA PET/CT: Series of Four Cases. Mol Imaging Radionucl Ther 2022; 31:223-226. [PMID: 36268896 PMCID: PMC9586004 DOI: 10.4274/mirt.galenos.2021.41033] [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] [Indexed: 12/01/2022] Open
Abstract
Prostate-specific membrane antigen (PSMA) is a transmembrane protein with overexpression in most prostate cancer cells. Gallium-68-(68Ga) PSMA positron emission tomography/computed tomography (PET/CT) imaging is a game-changer in the management of prostate cancer. 68Ga PSMA PET/CT scan is advanced and a promising radioligand has high sensitivity in determining lesions of prostate cancer with a high tumor to background ratio. The most common areas of metastasis are the bone and pelvic lymph nodes. The prognosis of prostate cancer is mainly determined by the status of metastases. The presence and the localization of metastases affects treatment planning. In our cases, we presented some examples of uncommon sites of metastases such as the brain, adrenal glands, penis and orbit. Improvements in imaging techniques, such as 68Ga PSMA PET/CT have led to the possibility to make more determi nation of rare metastase sites in prostate cancer patients.
Collapse
Affiliation(s)
- Gözde Mütevelizade
- Manisa Celal Bayar University Faculty of Medicine, Department of Nuclear Medicine, Manisa, Turkey
| | - Ceren Sezgin
- Manisa Celal Bayar University Faculty of Medicine, Department of Nuclear Medicine, Manisa, Turkey
| | - Gül Gümüşer
- Manisa Celal Bayar University Faculty of Medicine, Department of Nuclear Medicine, Manisa, Turkey
| | - Elvan Sayit
- Manisa Celal Bayar University Faculty of Medicine, Department of Nuclear Medicine, Manisa, Turkey
| |
Collapse
|
17
|
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.
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Brenner AW, Patel AJ. Review of Current Principles of the Diagnosis and Management of Brain Metastases. Front Oncol 2022; 12:857622. [PMID: 35686091 PMCID: PMC9171239 DOI: 10.3389/fonc.2022.857622] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/25/2022] [Indexed: 12/25/2022] Open
Abstract
Brain metastases are the most common intracranial tumors and are increasing in incidence as overall cancer survival improves. Diagnosis of brain metastases involves both clinical examination and magnetic resonance imaging. Treatment may involve a combination of surgery, radiotherapy, and systemic medical therapy depending on the patient’s neurologic status, performance status, and overall oncologic burden. Advances in these domains have substantially impacted the management of brain metastases and improved performance status and survival for some patients. Indications for surgery have expanded with improved patient selection, imaging, and intraoperative monitoring. Robust evidence supports the use of whole brain radiotherapy and stereotactic radiosurgery, for both standalone and adjuvant indications, in almost all patients. Lastly, while systemic medical therapy has historically provided little benefit, modern immunotherapeutic agents have demonstrated promise. Current investigation seeks to determine the utility of neoadjuvant radiotherapy and laser interstitial thermal therapy, which have shown benefit in limited studies to date. This article provides a review of the epidemiology, pathology, diagnosis, and treatment of brain metastases and the corresponding supporting evidence.
Collapse
Affiliation(s)
- Alex W Brenner
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| |
Collapse
|
20
|
Ibrahim S, Reddy V, Menon G. Intra-Parenchymal Cerebellar Metastasis—A Rare Presentation of Castration-Resistant Prostate Cancer. J Neurosci Rural Pract 2022; 13:558-560. [PMID: 35946005 PMCID: PMC9357486 DOI: 10.1055/s-0042-1745819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
AbstractIntracranial metastases from prostate carcinoma are uncommon and usually manifest as dural secondaries in the supratentorial compartment. We present an unusual case of intra-parenchymal posterior fossa prostatic metastasis in a 61-year-old gentleman and discuss the diagnostic and management challenges involved. A 61-year-old hypertensive, diabetic man presented with gait unsteadiness for 1-month duration and no other neurological deficits. He had previously undergone bilateral orchiectomy for prostate carcinoma with multiple osseous metastases. Magnetic resonance imaging showed a well-defined lobulated, intraventricular, peripherally enhancing lesion in the fourth ventricle with obstructive hydrocephalus. He underwent sub-occipital craniectomy and decompression, and histological examination was consistent with metastatic prostate adenocarcinoma. Although cerebellar secondaries are atypical, a suspicion of metastasis should be upheld in all patients with the history of prostate carcinoma, regardless of their location and radiological characteristics of the intracranial lesion.
Collapse
Affiliation(s)
- Sufyan Ibrahim
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Vyjayanth Reddy
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| |
Collapse
|
21
|
Pobel C, Laurent E, Florence AM, Fromont G, Calais G, Narciso B, Linassier C, Cancel M. Impact of novel hormonal agents (abiraterone, enzalutamide) on the development of visceral and/or brain metastases in patients with bone-metastatic castration-resistant prostate cancer. Clin Genitourin Cancer 2022; 20:495.e1-495.e9. [DOI: 10.1016/j.clgc.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 11/03/2022]
|
22
|
Ryman‐Tubb T, Lothion‐Roy JH, Metzler VM, Harris AE, Robinson BD, Rizvanov AA, Jeyapalan JN, James VH, England G, Rutland CS, Persson JL, Kenner L, Rubin MA, Mongan NP, de Brot S. Comparative pathology of dog and human prostate cancer. Vet Med Sci 2022; 8:110-120. [PMID: 34628719 PMCID: PMC8788985 DOI: 10.1002/vms3.642] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Though relatively rare in dogs, prostate cancer (PCa) is the most common non-cutaneous cancer in men. Human and canine prostate glands share many functional, anatomical and physiological features. Due to these similarities, canine PCa has been proposed as a model for PCa in men. PCa is typically androgen-dependent at diagnosis in men and for this reason, androgen deprivation therapies (ADT) are important treatments for advanced PCa in men. In contrast, there is some evidence that PCa is diagnosed more commonly in castrate dogs, at which point, limited therapeutic options are available. In men, a major limitation of current ADT is that progression to a lethal and incurable form of PCa, termed castrate-resistant prostate cancer (CRPC), is common. There is, therefore, an urgent need for a better understanding of the mechanism of PCa initiation and progression to CRPC to enable the development of novel therapeutic approaches. This review focuses on the functional, physiological, endocrine and histopathological similarities and differences in the prostate gland of these species. In particular, we focus on common physiological roles for androgen signalling in the prostate of men and dogs, we review the short- and longer-term effects of castration on PCa incidence and progression in the dog and relate how this knowledge may be relevant to understanding the mechanisms of CRPC in men.
Collapse
Affiliation(s)
- Toby Ryman‐Tubb
- BioDiscovery InstituteSchool of Veterinary Medicine and ScienceUniversity of NottinghamNottinghamUK
| | - Jennifer H. Lothion‐Roy
- BioDiscovery InstituteSchool of Veterinary Medicine and ScienceUniversity of NottinghamNottinghamUK
| | - Veronika M. Metzler
- BioDiscovery InstituteSchool of Veterinary Medicine and ScienceUniversity of NottinghamNottinghamUK
| | - Anna E. Harris
- BioDiscovery InstituteSchool of Veterinary Medicine and ScienceUniversity of NottinghamNottinghamUK
| | | | - Albert A. Rizvanov
- BioDiscovery InstituteSchool of Veterinary Medicine and ScienceUniversity of NottinghamNottinghamUK
- Institute of Fundamental Medicine and ScienceKazan Federal UniversityKazanTatarstanRussia
| | - Jennie N. Jeyapalan
- BioDiscovery InstituteSchool of Veterinary Medicine and ScienceUniversity of NottinghamNottinghamUK
| | - Victoria H. James
- BioDiscovery InstituteSchool of Veterinary Medicine and ScienceUniversity of NottinghamNottinghamUK
| | - Gary England
- BioDiscovery InstituteSchool of Veterinary Medicine and ScienceUniversity of NottinghamNottinghamUK
| | - Catrin S. Rutland
- BioDiscovery InstituteSchool of Veterinary Medicine and ScienceUniversity of NottinghamNottinghamUK
| | - Jenny L. Persson
- Department of Molecular BiologyUmeå UniversitetUmeåSweden
- Department of Biomedical SciencesMalmö UniversitetMalmöSweden
| | - Lukas Kenner
- Department of Experimental PathologyLaboratory Animal Pathology Medical University WienViennaAustria
| | - Mark A. Rubin
- Bern Center for Precision MedicineUniversity of Bern and InselspitalBernSwitzerland
- Department of BioMedical ResearchUniversity of Bern and InselspitalBernSwitzerland
| | - Nigel P. Mongan
- BioDiscovery InstituteSchool of Veterinary Medicine and ScienceUniversity of NottinghamNottinghamUK
- Department of PharmacologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - Simone de Brot
- BioDiscovery InstituteSchool of Veterinary Medicine and ScienceUniversity of NottinghamNottinghamUK
- COMPATH, Institute of Animal PathologyUniversity of BernBernSwitzerland
| |
Collapse
|
23
|
Nellaiappan HS, Rajaraman V, Halanaik D, Ananthakrrishnan R. Incidental Detection of Asymptomatic Brain Metastases Due to Carcinoma Prostate in Ga-68 PSMA HBED-CC Positron Emission Tomography-Computed Tomography: Reiterating its Superiority in Assessing Disease Status. Indian J Nucl Med 2022; 37:99-100. [PMID: 35478671 PMCID: PMC9037885 DOI: 10.4103/ijnm.ijnm_100_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 11/21/2022] Open
Abstract
Brain metastasis originating in adenocarcinoma of the prostate is rare and can be expected in cases of disseminated bone and soft-tissue disease. Asymptomatic brain metastasis is rare at any point of the disease stage. Ga-68 PSMA positron emission tomography-computed tomography (PET-CT) is one of the useful investigations for assessing the disease status in adenocarcinoma of the prostate. We report a case of asymptomatic brain metastases detected in Ga-68 PSMA PET-CT scan.
Collapse
Affiliation(s)
- Harihara Sudhan Nellaiappan
- Department of Nuclear Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Vishnukumar Rajaraman
- Department of Nuclear Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Dhanapathi Halanaik
- Department of Nuclear Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India,Address for correspondence: Dr. Dhanapathi Halanaik, Department of Nuclear Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India. E-mail :
| | - Ramesh Ananthakrrishnan
- Department of Radiodiagnosis, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| |
Collapse
|
24
|
Wang J, Tawbi HA. Emergent immunotherapy approaches for brain metastases. Neurooncol Adv 2021; 3:v43-v51. [PMID: 34859232 PMCID: PMC8633738 DOI: 10.1093/noajnl/vdab138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Brain metastases from solid tumors are increasing in incidence, especially as outcomes of systemic therapies continue to extend patients’ overall survival. The long-held notion that the brain is an immune sanctuary has now been largely refuted with increasing evidence that immunotherapy can induce durable responses in brain metastases. Single agent immune checkpoint inhibition with anti-CTLA4 and anti-PD1 antibodies induces durable responses in 15%–20% in melanoma brain metastases as long as patients are asymptomatic and do not require corticosteroids. The combination of anti-CTLA4 with anti-PD-1 antibodies induces an intracranial response in over 50% of asymptomatic melanoma patients, and much lower rate of otherwise durable responses (20%) in symptomatic patients or those on steroids. Data in other cancers, such as renal cell carcinoma, are accumulating indicating a role for immunotherapy. Emerging immunotherapy approaches will have to focus on increasing response rates, decreasing toxicity, and decreasing steroid dependency. The path to those advances will have to include a better understanding of the mechanisms of response and resistance to immunotherapy in brain metastases, the use of novel agents such as anti-LAG3 checkpoint inhibitors, targeted therapy (oncogene directed or TKIs), and possibly surgery and SRS to improve the outcomes of patients with brain metastases.
Collapse
Affiliation(s)
- Jianbo Wang
- Department of Genitourinary Malignancies, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Hussein A Tawbi
- Department of Melanoma Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
25
|
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]
|
26
|
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.
Collapse
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
| |
Collapse
|
27
|
Sena LA, Salles DC, Engle EL, Zhu Q, Tukachinsky H, Lotan TL, Antonarakis ES. Mismatch repair-deficient prostate cancer with parenchymal brain metastases treated with immune checkpoint blockade. Cold Spring Harb Mol Case Stud 2021; 7:mcs.a006094. [PMID: 34140335 PMCID: PMC8327884 DOI: 10.1101/mcs.a006094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/19/2021] [Indexed: 12/19/2022] Open
Abstract
Parenchymal brain metastases from prostate cancer are unusual and are associated with poor prognosis. Given the rarity of this entity, little is known about its molecular and histologic characteristics. Here we describe a patient with metastatic castration-resistant, mismatch repair-deficient (dMMR) prostate cancer with parenchymal brain metastases. Analysis of a brain metastasis revealed MLH1 loss consistent with dMMR, yet few tumor-infiltrating lymphocytes (TILs). He was treated with immune checkpoint blockade (ICB) and exhibited an extra-central nervous system (CNS) systemic response but CNS progression. Subsequent assessment of a brain metastasis following ICB treatment surprisingly showed increased TIL density and depletion of macrophages, suggestive of an enhanced antitumor immune response. Post-treatment tumoral DNA sequencing did not reveal acquired mutations that might confer resistance to ICB. This is the first description of ICB therapy for a patient with prostate cancer with parenchymal brain metastases, with pre- and post-treatment immunogenomic analyses.
Collapse
Affiliation(s)
- Laura A Sena
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.,The Bloomberg∼Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Daniela C Salles
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Elizabeth L Engle
- The Bloomberg∼Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.,Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Qingfeng Zhu
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | | | - Tamara L Lotan
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Emmanuel S Antonarakis
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.,The Bloomberg∼Kimmel Institute for Cancer Immunotherapy, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| |
Collapse
|
28
|
Hajal C, Shin Y, Li L, Serrano JC, Jacks T, Kamm RD. The CCL2-CCR2 astrocyte-cancer cell axis in tumor extravasation at the brain. SCIENCE ADVANCES 2021; 7:eabg8139. [PMID: 34162553 PMCID: PMC8221620 DOI: 10.1126/sciadv.abg8139] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/11/2021] [Indexed: 05/12/2023]
Abstract
Although brain metastases are common in cancer patients, little is known about the mechanisms of cancer extravasation across the blood-brain barrier (BBB), a key step in the metastatic cascade that regulates the entry of cancer cells into the brain parenchyma. Here, we show, in a three-dimensional in vitro BBB microvascular model, that astrocytes promote cancer cell transmigration via their secretion of C-C motif chemokine ligand 2 (CCL2). We found that this chemokine, produced primarily by astrocytes, promoted the chemotaxis and chemokinesis of cancer cells via their C-C chemokine receptor type 2 (CCR2), with no notable changes in vascular permeability. These findings were validated in vivo, where CCR2-deficient cancer cells exhibited significantly reduced rates of arrest and transmigration in mouse brain capillaries. Our results reveal that the CCL2-CCR2 astrocyte-cancer cell axis plays a fundamental role in extravasation and, consequently, metastasis to the brain.
Collapse
Affiliation(s)
- Cynthia Hajal
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Yoojin Shin
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Leanne Li
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jean Carlos Serrano
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Tyler Jacks
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Biology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Howard Hughes Medical Institute, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Roger D Kamm
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| |
Collapse
|
29
|
Oliveira-Barros EGD, Branco LC, Da Costa NM, Nicolau-Neto P, Palmero C, Pontes B, Ferreira do Amaral R, Alves-Leon SV, Marcondes de Souza J, Romão L, Fernandes PV, Martins I, Takiya CM, Ribeiro Pinto LF, Palumbo A, Nasciutti LE. GLIPR1 and SPARC expression profile reveals a signature associated with prostate Cancer Brain metastasis. Mol Cell Endocrinol 2021; 528:111230. [PMID: 33675864 DOI: 10.1016/j.mce.2021.111230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 02/07/2023]
Abstract
Despite advances in treatment of lethal prostate cancer, the incidence of prostate cancer brain metastases is increasing. In this sense, we analyzed the molecular profile, as well as the functional consequences involved in the reciprocal interactions between prostate tumor cells and human astrocytes. We observed that the DU145 cells, but not the LNCaP cells or the RWPE-1 cells, exhibited more pronounced, malignant and invasive phenotypes along their interactions with astrocytes. Moreover, global gene expression analysis revealed several genes that were differently expressed in our co-culture models with the overexpression of GLIPR1 and SPARC potentially representing a molecular signature associated with the invasion of central nervous system by prostate malignant cells. Further, these results were corroborated by immunohistochemistry and in silico analysis. Thus, we conjecture that the data here presented may increase the knowledge about the molecular mechanisms associated with the invasion of CNS by prostate malignant cells.
Collapse
Affiliation(s)
- Eliane Gouvêa de Oliveira-Barros
- Programa de Pesquisa Em Biologia Celular e do Desenvolvimento, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro (UFRJ), Cidade Universitária-Ilha do Fundão, Rio de Janeiro, CEP 21941-902, Brazil; Laboratório de Biologia Celular, Departamento de Biologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora (UFJF), Rua José Lourenço Kelmer-Campus, São Pedro, Juiz de Fora, CEP: 36036-900, Brazil.
| | - Luíza Castello Branco
- Programa de Pesquisa Em Biologia Celular e do Desenvolvimento, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro (UFRJ), Cidade Universitária-Ilha do Fundão, Rio de Janeiro, CEP 21941-902, Brazil.
| | - Nathalia Meireles Da Costa
- Programa de Carcinogênese Molecular, Centro de Pesquisas, Instituto Nacional de Câncer (INCA), Rua André Cavalcanti, 37-Centro, Rio de Janeiro, CEP 20231-050, Brazil.
| | - Pedro Nicolau-Neto
- Programa de Carcinogênese Molecular, Centro de Pesquisas, Instituto Nacional de Câncer (INCA), Rua André Cavalcanti, 37-Centro, Rio de Janeiro, CEP 20231-050, Brazil.
| | - Celia Palmero
- Programa de Pesquisa Em Biologia Celular e do Desenvolvimento, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro (UFRJ), Cidade Universitária-Ilha do Fundão, Rio de Janeiro, CEP 21941-902, Brazil; UFRJ/Polo Macaé, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Bruno Pontes
- Programa de Pesquisa Em Biologia Celular e do Desenvolvimento, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro (UFRJ), Cidade Universitária-Ilha do Fundão, Rio de Janeiro, CEP 21941-902, Brazil; Centro Nacional de Biologia Estrutural e Bioimagem (CENABIO), Universidade Federal do Rio de Janeiro (UFRJ), Cidade Universitária-Ilha do Fundão, Rio de Janeiro, CEP 21941-902, Brazil.
| | - Rackele Ferreira do Amaral
- Programa de Pesquisa Em Biologia Celular e do Desenvolvimento, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro (UFRJ), Cidade Universitária-Ilha do Fundão, Rio de Janeiro, CEP 21941-902, Brazil.
| | - Soniza Vieira Alves-Leon
- Hospital Universitário Clementino Fraga Filho (HUCFF), Universidade Federal do Rio de Janeiro (UFRJ), Cidade Universitária-Ilha do Fundão, Rio de Janeiro, CEP 21941-902, Brazil.
| | - Jorge Marcondes de Souza
- Hospital Universitário Clementino Fraga Filho (HUCFF), Universidade Federal do Rio de Janeiro (UFRJ), Cidade Universitária-Ilha do Fundão, Rio de Janeiro, CEP 21941-902, Brazil.
| | - Luciana Romão
- Programa de Pesquisa Em Biologia Celular e do Desenvolvimento, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro (UFRJ), Cidade Universitária-Ilha do Fundão, Rio de Janeiro, CEP 21941-902, Brazil.
| | - Priscila Valverde Fernandes
- Divisão de Patologia, Instituto Nacional de Câncer (INCA), Rua Cordeiro da Graça, 156 - Santo Cristo, Rio de Janeiro, CEP: 20220 -040, Brazil.
| | - Ivanir Martins
- Divisão de Patologia, Instituto Nacional de Câncer (INCA), Rua Cordeiro da Graça, 156 - Santo Cristo, Rio de Janeiro, CEP: 20220 -040, Brazil.
| | - Christina Maeda Takiya
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro (UFRJ), Cidade Universitária-Ilha do Fundão, Rio de Janeiro, CEP 21941-902, Brazil.
| | - Luis Felipe Ribeiro Pinto
- Programa de Carcinogênese Molecular, Centro de Pesquisas, Instituto Nacional de Câncer (INCA), Rua André Cavalcanti, 37-Centro, Rio de Janeiro, CEP 20231-050, Brazil.
| | - Antonio Palumbo
- Programa de Pesquisa Em Biologia Celular e do Desenvolvimento, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro (UFRJ), Cidade Universitária-Ilha do Fundão, Rio de Janeiro, CEP 21941-902, Brazil.
| | - Luiz Eurico Nasciutti
- Programa de Pesquisa Em Biologia Celular e do Desenvolvimento, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro (UFRJ), Cidade Universitária-Ilha do Fundão, Rio de Janeiro, CEP 21941-902, Brazil.
| |
Collapse
|
30
|
McBean R, Tatkovic A, Wong DC. Intracranial Metastasis from Prostate Cancer: Investigation, Incidence, and Imaging Findings in a Large Cohort of Australian Men. J Clin Imaging Sci 2021; 11:24. [PMID: 33948339 PMCID: PMC8088474 DOI: 10.25259/jcis_52_2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/31/2021] [Indexed: 12/11/2022] Open
Abstract
Objectives: Prostate cancer metastasizing to the brain is remarkably uncommon, with the incidence never having been described in the modern setting. The objective of this study was to determine the incidence and imaging pattern of intracranial metastasis from prostate cancer in a large cohort of Australian men with prostate cancer. Material and Methods: Retrospective review was undertaken of imaging reports for all known prostate cancer patients, who underwent an imaging examination inclusive of the brain, between July 1, 2014, and July 1, 2020. Once an intracranial lesion was identified, all available imaging and clinical notes were reviewed. Results: A total of 5644 imaging examinations which included the brain were identified in 4341 prostate cancer patients. The majority (92.1%) of examinations were 68-Gallium-labeled prostate-specific membrane antigen (68Ga-PSMA) positron emission tomography/computed tomography (PET/CT). Eight patients were identified as having an intracranial metastasis from prostate cancer, yielding an incidence of 0.18%. All patients had a Gleason score of 9 (where known), and the majority of patients (5/8) had a non-acinar variant of prostate cancer. At the time of diagnosis of intracranial metastasis, all patients had extensive metastatic disease. Imaging characteristics of the intracranial lesions were highly variable. Conclusion: The incidence of intracranial metastasis in prostate cancer patients has never been well-established. In this study, we determined the incidence as being 0.18%. Given the majority of metastasis constituted unexpected findings on routine restaging 68Ga-PSMA PET/CT, the incidence determined in our study is arguably the most accurate and clinically relevant described to date.
Collapse
Affiliation(s)
- Rhiannon McBean
- I-MED Radiology, The Wesley Hospital, Brisbane, Queensland, Australia
| | - Annaleis Tatkovic
- I-MED Radiology, The Wesley Hospital, Brisbane, Queensland, Australia
| | - David Chee Wong
- I-MED Radiology, The Wesley Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
31
|
Myint ZW, Qasrawi AH. Prostate Adenocarcinoma with Brain Metastasis: A Surveillance, Epidemiology, and End Results Database Analysis 2010-2015. Med Sci Monit 2021; 27:e930064. [PMID: 33840808 PMCID: PMC8051164 DOI: 10.12659/msm.930064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Prostate adenocarcinoma rarely metastasize to the brain. The aim of this study was to understand the risk association and survival outcomes comparing prostate cancer with brain metastasis (group 1) with prostate cancer without brain metastasis (group 2) at the time of initial diagnosis. Material/Methods We searched the Surveillance, Epidemiology, and End Results (SEER) statewide cancer registries for all cases of stage IV prostate cancer adenocarcinoma diagnosed between 2010 and 2015. We used the Kaplan-Meier method and Cox regression to analyze survival outcomes and logistic regression to study the association between the presence of brain metastasis and potential risk variables. Exclusion criteria were the presence of neuroendocrine and small cell histology. Results The study included 14 753 patients. Of these, 187 patients were in group 1 (with brain metastasis) and 14 566 were in group 2 (without brain metastasis). When comparing the metastases distribution at the time of initial presentation between group 1 and group 2, the occurrence of bone metastasis was similar in the 2 groups (87% vs 90%); however, liver metastasis (13% vs 4%) and lung metastasis (29% vs 7%) were significantly higher in group 1. We found a strong association between brain metastasis and visceral metastasis. There was no association between age, race, and grade and having brain metastasis. Conclusions Our analysis shows that visceral metastasis is associated with a higher risk of brain metastasis. Presence of a visceral metastasis can be a useful parameter to consider early magnetic resonance imaging of the brain to facilitate diagnosis of asymptomatic brain metastasis.
Collapse
Affiliation(s)
- Zin W Myint
- Department of Internal Medicine, Division of Medical Oncology, University of Kentucky, Lexington, KY, USA
| | - Ayman H Qasrawi
- Department of Internal Medicine, Division of Medical Oncology, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
32
|
Richardson W, Satarasinghe P, Wang M, Rose J, Ashour R. Intraventricular brain mass causing obstructive hydrocephalus: A rare location of prostate cancer metastasis. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
33
|
Gosein M, Mohammed L, Chan A, Sinanan A, Banfield R, Maharaj P, Narinesingh D. A pictorial review of the less commonly encountered patterns of metastatic prostate carcinoma. Ecancermedicalscience 2021; 14:1159. [PMID: 33574904 PMCID: PMC7864691 DOI: 10.3332/ecancer.2020.1159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Indexed: 11/06/2022] Open
Abstract
Usually late in the course of advanced prostate carcinoma, atypical nodal and distant metastases may be encountered. Accurate characterisation of disease spread and assessment of disease response have significant treatment and prognostic implications. Surveillance imaging, therefore, along with clinical and biochemical parameters, is a key factor in directing appropriate management. Atypical metastases may also require histological re-evaluation, as they may indicate differentiation into aggressive histologic subtypes, which can lead to management alteration. We present a pictorial review of the less common patterns of metastatic prostate carcinoma, to aid in timely recognition and diagnosis.
Collapse
Affiliation(s)
- Maria Gosein
- Port of Spain General Hospital, Charlotte Street, Port of Spain, Trinidad.,University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad.,https://orcid.org/0000-0002-2059-039X
| | - Laura Mohammed
- Port of Spain General Hospital, Charlotte Street, Port of Spain, Trinidad
| | - Adrian Chan
- Port of Spain General Hospital, Charlotte Street, Port of Spain, Trinidad
| | - Alexander Sinanan
- Port of Spain General Hospital, Charlotte Street, Port of Spain, Trinidad.,University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad
| | - Renee Banfield
- University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad.,San Fernando General Hospital, Paradise Pasture, Independence Avenue, San Fernando, Trinidad
| | - Paramanand Maharaj
- University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad.,Eric Williams Medical Sciences Complex, Uriah Butler Highway, Champs Fleurs, Trinidad
| | - Dylan Narinesingh
- Port of Spain General Hospital, Charlotte Street, Port of Spain, Trinidad.,University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad
| |
Collapse
|
34
|
Rebello RJ, Oing C, Knudsen KE, Loeb S, Johnson DC, Reiter RE, Gillessen S, Van der Kwast T, Bristow RG. Prostate cancer. Nat Rev Dis Primers 2021. [PMID: 33542230 DOI: 10.1038/s41572-020-0024.3-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Abstract
Prostate cancer is a complex disease that affects millions of men globally, predominantly in high human development index regions. Patients with localized disease at a low to intermediate risk of recurrence generally have a favourable outcome of 99% overall survival for 10 years if the disease is detected and treated at an early stage. Key genetic alterations include fusions of TMPRSS2 with ETS family genes, amplification of the MYC oncogene, deletion and/or mutation of PTEN and TP53 and, in advanced disease, amplification and/or mutation of the androgen receptor (AR). Prostate cancer is usually diagnosed by prostate biopsy prompted by a blood test to measure prostate-specific antigen levels and/or digital rectal examination. Treatment for localized disease includes active surveillance, radical prostatectomy or ablative radiotherapy as curative approaches. Men whose disease relapses after prostatectomy are treated with salvage radiotherapy and/or androgen deprivation therapy (ADT) for local relapse, or with ADT combined with chemotherapy or novel androgen signalling-targeted agents for systemic relapse. Advanced prostate cancer often progresses despite androgen ablation and is then considered castration-resistant and incurable. Current treatment options include AR-targeted agents, chemotherapy, radionuclides and the poly(ADP-ribose) inhibitor olaparib. Current research aims to improve prostate cancer detection, management and outcomes, including understanding the fundamental biology at all stages of the disease.
Collapse
Affiliation(s)
- Richard J Rebello
- Cancer Research UK Manchester Institute, University of Manchester, Manchester Cancer Research Centre, Manchester, UK
| | - Christoph Oing
- Cancer Research UK Manchester Institute, University of Manchester, Manchester Cancer Research Centre, Manchester, UK
- Department of Oncology, Haematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Centre Eppendorf, Hamburg, Germany
| | - Karen E Knudsen
- Sidney Kimmel Cancer Center at Jefferson Health and Thomas Jefferson University, Philadelphia, PA, USA
| | - Stacy Loeb
- Department of Urology and Population Health, New York University and Manhattan Veterans Affairs, Manhattan, NY, USA
| | - David C Johnson
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | - Robert E Reiter
- Department of Urology, Jonssen Comprehensive Cancer Center UCLA, Los Angeles, CA, USA
| | | | - Theodorus Van der Kwast
- Laboratory Medicine Program, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
| | - Robert G Bristow
- Cancer Research UK Manchester Institute, University of Manchester, Manchester Cancer Research Centre, Manchester, UK.
| |
Collapse
|
35
|
Abstract
Prostate cancer is a complex disease that affects millions of men globally, predominantly in high human development index regions. Patients with localized disease at a low to intermediate risk of recurrence generally have a favourable outcome of 99% overall survival for 10 years if the disease is detected and treated at an early stage. Key genetic alterations include fusions of TMPRSS2 with ETS family genes, amplification of the MYC oncogene, deletion and/or mutation of PTEN and TP53 and, in advanced disease, amplification and/or mutation of the androgen receptor (AR). Prostate cancer is usually diagnosed by prostate biopsy prompted by a blood test to measure prostate-specific antigen levels and/or digital rectal examination. Treatment for localized disease includes active surveillance, radical prostatectomy or ablative radiotherapy as curative approaches. Men whose disease relapses after prostatectomy are treated with salvage radiotherapy and/or androgen deprivation therapy (ADT) for local relapse, or with ADT combined with chemotherapy or novel androgen signalling-targeted agents for systemic relapse. Advanced prostate cancer often progresses despite androgen ablation and is then considered castration-resistant and incurable. Current treatment options include AR-targeted agents, chemotherapy, radionuclides and the poly(ADP-ribose) inhibitor olaparib. Current research aims to improve prostate cancer detection, management and outcomes, including understanding the fundamental biology at all stages of the disease.
Collapse
|
36
|
Junqueira MZ, Rocha NH, Sapienza MT. 68Ga-Prostate-Specific Membrane Antigen PET/CT Uptake in Intraventricular Meningioma in the Choroid Plexus. Clin Nucl Med 2021; 46:58-59. [PMID: 33234918 DOI: 10.1097/rlu.0000000000003394] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 68-year-old man in whom a prostate cancer biochemical recurrence was being investigated was referred for a full-body Ga-prostate-specific membrane antigen PET/CT. Focal uptake in a lesion on the choroid plexus projection was detected. Patient had no neurological complaints. A previous MRI performed 4 years ago showed the same lesion. According to the location and radiological and clinical characteristics, the diagnosis of meningioma was defined. The interpretation of prostate-specific membrane antigen PET/CT must take into account the low frequency of metastases in sites such as the central nervous system, and the possibility of intense uptake in lesions unrelated to prostate cancer.
Collapse
|
37
|
Ogunbona OB, Goodman AL, Osunkoya AO. Metastatic prostatic adenocarcinoma to the brain and spinal cord: a contemporary clinicopathologic analysis of 30 cases. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2021; 14:45-53. [PMID: 33532022 PMCID: PMC7847485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/29/2020] [Indexed: 06/12/2023]
Abstract
Metastatic prostatic adenocarcinoma (PCa) to lymph nodes and bone is well documented in the literature, however only case reports and small series of metastatic PCa to the brain and spinal cord with clinicopathologic analysis have been published. We identified 30 cases of metastatic PCa to the brain and spinal cord. The mean patient age was 67 years (range: 50 to 87 years). Thirteen (43%) cases involved the brain and 17 (57%) cases involved the spinal cord. Most of the cases (60%) were a single mass. Of the 13 cases involving the brain, the temporal lobe 6 (46%) was the most common site and the spinal cord lesions involved the thoracic region in 13/17 (76%) cases. All patients had one or more metastases to other organs. In 8 patients, the brain or spinal cord metastasis was the initial diagnosis of PCa. In the patients that had prior prostate biopsy specimens available, the Gleason score ranged from 3+3=6 (Grade group 1: indicating unsampled higher grade PCa) to Gleason score 4+5=9 (Grade group 5). Follow-up was available in 21 cases with a mean duration of 20 months (range: 1 to 130 months). This is one of the largest clinicopathologic studies to date of metastatic PCa to the brain and spinal cord. Although rare, metastatic PCa should be considered in the differential diagnosis of a solitary brain or spinal cord mass in male patients, even over a decade after the initial diagnosis of PCa.
Collapse
Affiliation(s)
- Oluwaseun B Ogunbona
- Department of Pathology, Emory University School of MedicineAtlanta, GA 30322, USA
| | - Abigail L Goodman
- Department of Pathology, Emory University School of MedicineAtlanta, GA 30322, USA
| | - Adeboye O Osunkoya
- Department of Pathology, Emory University School of MedicineAtlanta, GA 30322, USA
- Department of Urology, Emory University School of MedicineAtlanta, GA 30322, USA
- Department of Pathology, Veterans Affairs Medical CenterDecatur, GA 30033, USA
- Winship Cancer Institute of Emory UniversityAtlanta, GA 30322, USA
| |
Collapse
|
38
|
Son Y, Chialastri P, Scali JT, Mueller TJ. Metastatic Adenocarcinoma of the Prostate to the Brain Initially Suspected as Meningioma by Magnetic Resonance Imaging. Cureus 2020; 12:e12285. [PMID: 33520493 PMCID: PMC7834587 DOI: 10.7759/cureus.12285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Brain metastasis from prostate cancer is rare, occurring in less than 1% of metastatic prostate cancer patients. Brain metastasis can cause edema, neurologic symptoms, and may be misdiagnosed as primary brain tumors on imaging. A 68-year-old male presented to the emergency department complaining of headaches, right-sided weakness, multiple falls, and a 45 pounds of unintentional weight loss. Computerized tomography (CT) scan without contrast of the head showed a 3.2 cm right frontal mass with edema suspicious for meningioma. Associated nonspecific bony lesions were found on CT of the abdomen and pelvis. Magnetic resonance imaging (MRI) of the brain showed a 2.8 cm right frontal mass with an enhanced dural tail. Preoperative labs were noteworthy for a hemoglobin of 9.7 and prostate-specific antigen (PSA) of 66.7 ng/ml. Craniotomy with resection of tumor was performed with a frozen sample diagnosed as meningioma. Permanent pathology with stains were positive for PSA and prostatic-specific acid phosphatase (PSAP), making the diagnosis of metastatic prostate adenocarcinoma. Postoperatively, nuclear bone scan showed uptake in the axial skeleton consistent with metastasis. After the diagnosis of metastatic prostate cancer was made, bicalutamide was administered followed by degarelix with plans to transition to leuprorelin one month later. This is to be followed up by whole brain radiation therapy (WBRT). PSA was 118.53 ng/ml three weeks after craniotomy, but prior to androgen deprivation therapy. Metastatic prostate cancer can present with neurological symptoms most commonly following spread to the axial skeleton and impingement of the spinal cord. Metastasis to the brain is rare and is usually associated with vague symptomatology depending on extent and location of the lesion. While brain metastasis can occur in known prostate cancer patients, this case shows that metastasis can occur prior to any formal prostate cancer diagnosis and can be mistaken for meningioma on imaging and frozen sectioning. Practitioners must be vigilant, and precautions should be taken to rule in metastatic prostate cancer as a possible cause for a brain lesion in patients of the appropriate demographics.
Collapse
Affiliation(s)
- Young Son
- Urology, Rowan University School of Osteopathic Medicine, Stratford, USA
| | - Paul Chialastri
- Urology, Rowan University School of Osteopathic Medicine, Stratford, USA
| | - Julia T Scali
- Urology, Rowan University School of Osteopathic Medicine, Stratford, USA
| | | |
Collapse
|
39
|
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.
Collapse
|
40
|
Liu S, Qavi AH, Kim Y, Basak P, Jesmajian S. Intracranial metastasis from prostate adenocarcinoma: a case report and literature review. J Community Hosp Intern Med Perspect 2020; 10:583-586. [PMID: 33194134 PMCID: PMC7599009 DOI: 10.1080/20009666.2020.1811069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Intracranial metastasis from prostate adenocarcinoma is rare. A 70-year-old African American male with a history of prostate adenocarcinoma for the last 14 years, presented to our hospital complaining of generalized weakness for the past 2 weeks. He was found to have fever with left ptosis and mild eyelid edema. Brain MRI showed dural metastasis. Two months after the first presentation, he was readmitted with a suspected acute cerebral vascular accident (CVA). CT brain showed vasogenic edema in the right subcortical, likely from intracranial metastasis. His acute neurological symptoms improved with intravenous dexamethasone. This case highlights the possibility of intracranial metastasis from prostate adenocarcinoma. With the advent of novel therapies for prostate cancer, which prolong life expectancy, intracranial metastasis from prostate adenocarcinoma may become an increasingly frequent clinical scenario.
Collapse
Affiliation(s)
- Suhu Liu
- Department of Internal Medicine, Albert Einstein College of Medicine, New Rochelle, NY, USA
| | - Ahmed Hassaan Qavi
- Department of Internal Medicine, Albert Einstein College of Medicine, New Rochelle, NY, USA
| | - Yoel Kim
- Department of Internal Medicine, Albert Einstein College of Medicine, New Rochelle, NY, USA
| | - Prasanta Basak
- Department of Internal Medicine, Albert Einstein College of Medicine, New Rochelle, NY, USA
| | - Stephen Jesmajian
- Department of Internal Medicine, Albert Einstein College of Medicine, New Rochelle, NY, USA
| |
Collapse
|
41
|
Prostate Cancer Central Nervous System Metastasis in a Contemporary Cohort. Clin Genitourin Cancer 2020; 19:217-222.e1. [PMID: 33069585 DOI: 10.1016/j.clgc.2020.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/30/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Central nervous system (CNS) metastasis from prostate cancer (PCA) is a rare event, but one with significant prognostic impact for those affected. There are limited data on its impact in contemporary cohorts treated with modern agents. PATIENTS AND METHODS A retrospective institutional review was performed to characterize the occurrence/outcome of PCA CNS metastasis on all cases of PCA from 2011 to 2017. A manual chart review was performed to confirm PCA CNS metastases in all cases identified through a diagnostic code screening of the health data. RESULTS A total of 6596 cases of PCA were identified, with 29 (20 dural and 9 intraparenchymal) confirmed cases of CNS metastases from PCA. The median survival from the time of diagnosis of CNS metastasis was 2.6 months (95% confidence interval, 2.04-10.78 months) and 5.41 months (95% confidence interval, 3.03 months to not reached) for dural and parenchymal metastases, respectively. Among those who developed CNS metastases, approximately 79% of patients had prior exposure to abiraterone and/or enzalutamide, of whom 50% had ≥ 6 months of exposure. Four (0.07%) of the 5841 patients developed CNS metastases prior to the initiation of therapy or on androgen deprivation therapy alone. In contrast, 24 (8.6%) of the 279 patients with 2 or more lines of medical therapy developed CNS metastases. CONCLUSIONS Our analysis highlights the continued poor prognosis of parenchymal and dural CNS metastases from PCA. CNS metastases in PCA remain a rare event with a 0.4% incidence in this series, but this incidence is considerably increased in patients who receive medical therapy beyond first-line androgen deprivation therapy.
Collapse
|
42
|
Dural Metastases of Advanced Prostate Cancer Detected by 18F-Fluorocholine. Diagnostics (Basel) 2020; 10:diagnostics10060385. [PMID: 32521789 PMCID: PMC7344590 DOI: 10.3390/diagnostics10060385] [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: 05/14/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 11/17/2022] Open
Abstract
Prostate cancer with extensive dural metastases is very rare, with only few cases described in the literature. We report one such case of a 74-year-old man with advanced prostate cancer, and in relatively good clinical condition. The patient returned with complaints of headache and diplopia. Fluorocholine (18F) chloride (18F-FCH) is an analog of choline in which a hydrogen atom has been replaced by fluorine (18F). After crossing the cell membrane by a carrier-mediated mechanism, choline is phosphorylated by choline kinase to produce phosphorylcholine. 18F-FCH positron emission tomography–computed tomography (PET/CT) is widely used to stage and restage patients affected by prostate cancer with good sensitivity. 18F-FCH PET/CT showed disease progression with the onset of multiple skull lesions. Numerous suspicious dural hypermetabolic lesions indicating neoplastic involvement were detected along the fronto-parietal convexities, in the left fronto-orbital region and right lateral wall of the orbit, concerning for metastases in these regions. A contrast-enhanced computed tomography (CECT) scan was performed which showed corresponding enhancing tissue which correlated with the PET findings. The final imaging diagnosis was osteo-dural metastases from prostate cancer associated with poor outcome. Awareness of this pattern of metastases may be of clinical relevance in order to avoid unnecessary invasive diagnostic procedures in groups of patients with a dismal prognosis.
Collapse
|
43
|
Crumbaker M, Chan EKF, Gong T, Corcoran N, Jaratlerdsiri W, Lyons RJ, Haynes AM, Kulidjian AA, Kalsbeek AMF, Petersen DC, Stricker PD, Jamieson CAM, Croucher PI, Hovens CM, Joshua AM, Hayes VM. The Impact of Whole Genome Data on Therapeutic Decision-Making in Metastatic Prostate Cancer: A Retrospective Analysis. Cancers (Basel) 2020; 12:E1178. [PMID: 32392735 PMCID: PMC7280976 DOI: 10.3390/cancers12051178] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/21/2020] [Accepted: 04/28/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND While critical insights have been gained from evaluating the genomic landscape of metastatic prostate cancer, utilizing this information to inform personalized treatment is in its infancy. We performed a retrospective pilot study to assess the current impact of precision medicine for locally advanced and metastatic prostate adenocarcinoma and evaluate how genomic data could be harnessed to individualize treatment. METHODS Deep whole genome-sequencing was performed on 16 tumour-blood pairs from 13 prostate cancer patients; whole genome optical mapping was performed in a subset of 9 patients to further identify large structural variants. Tumour samples were derived from prostate, lymph nodes, bone and brain. RESULTS Most samples had acquired genomic alterations in multiple therapeutically relevant pathways, including DNA damage response (11/13 cases), PI3K (7/13), MAPK (10/13) and Wnt (9/13). Five patients had somatic copy number losses in genes that may indicate sensitivity to immunotherapy (LRP1B, CDK12, MLH1) and one patient had germline and somatic BRCA2 alterations. CONCLUSIONS Most cases, whether primary or metastatic, harboured therapeutically relevant alterations, including those associated with PARP inhibitor sensitivity, immunotherapy sensitivity and resistance to androgen pathway targeting agents. The observed intra-patient heterogeneity and presence of genomic alterations in multiple growth pathways in individual cases suggests that a precision medicine model in prostate cancer needs to simultaneously incorporate multiple pathway-targeting agents. Our whole genome approach allowed for structural variant assessment in addition to the ability to rapidly reassess an individual's molecular landscape as knowledge of relevant biomarkers evolve. This retrospective oncological assessment highlights the genomic complexity of prostate cancer and the potential impact of assessing genomic data for an individual at any stage of the disease.
Collapse
Affiliation(s)
- Megan Crumbaker
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia; (M.C.); (E.K.F.C.); (T.G.); (W.J.); (R.J.L.); (A.-M.H.); (A.M.F.K.); (P.I.C.)
- St. Vincent’s Clinical School, University of New South Wales, Sydney, Randwick, NSW 2031, Australia
- Kinghorn Cancer Centre, Department of Medical Oncology, St. Vincent’s Hospital, Darlinghurst, NSW 2010, Australia
| | - Eva K. F. Chan
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia; (M.C.); (E.K.F.C.); (T.G.); (W.J.); (R.J.L.); (A.-M.H.); (A.M.F.K.); (P.I.C.)
- St. Vincent’s Clinical School, University of New South Wales, Sydney, Randwick, NSW 2031, Australia
| | - Tingting Gong
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia; (M.C.); (E.K.F.C.); (T.G.); (W.J.); (R.J.L.); (A.-M.H.); (A.M.F.K.); (P.I.C.)
- Central Clinical School, University of Sydney, Sydney, Camperdown, NSW 2050, Australia
| | - Niall Corcoran
- Australian Prostate Cancer Research Centre Epworth, Richmond, VIC 3121, Australia;
- Department of Surgery, University of Melbourne, Melbourne, VIC 3010, Australia
- Division of Urology, Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
| | - Weerachai Jaratlerdsiri
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia; (M.C.); (E.K.F.C.); (T.G.); (W.J.); (R.J.L.); (A.-M.H.); (A.M.F.K.); (P.I.C.)
| | - Ruth J. Lyons
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia; (M.C.); (E.K.F.C.); (T.G.); (W.J.); (R.J.L.); (A.-M.H.); (A.M.F.K.); (P.I.C.)
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia; (M.C.); (E.K.F.C.); (T.G.); (W.J.); (R.J.L.); (A.-M.H.); (A.M.F.K.); (P.I.C.)
| | - Anna A. Kulidjian
- Department of Orthopedic Surgery, Scripps Clinic, La Jolla, CA 92037, USA.;
- Orthopedic Oncology Program, Scripps MD Anderson Cancer Center, La Jolla, CA 92037, USA
| | - Anton M. F. Kalsbeek
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia; (M.C.); (E.K.F.C.); (T.G.); (W.J.); (R.J.L.); (A.-M.H.); (A.M.F.K.); (P.I.C.)
| | - Desiree C. Petersen
- The Centre for Proteomic and Genomic Research, Cape Town 7925, South Africa;
| | - Phillip D. Stricker
- Department of Urology, St. Vincent’s Hospital, Darlinghurst, NSW 2010, Australia;
| | - Christina A. M. Jamieson
- Department of Urology, Moores Cancer Center, University of California, San Diego, La Jolla, CA 92037, USA;
| | - Peter I. Croucher
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia; (M.C.); (E.K.F.C.); (T.G.); (W.J.); (R.J.L.); (A.-M.H.); (A.M.F.K.); (P.I.C.)
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, Randwick, NSW 2031, Australia
| | - Christopher M. Hovens
- Australian Prostate Cancer Research Centre Epworth, Richmond, VIC 3121, Australia;
- Department of Surgery, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Anthony M. Joshua
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia; (M.C.); (E.K.F.C.); (T.G.); (W.J.); (R.J.L.); (A.-M.H.); (A.M.F.K.); (P.I.C.)
- St. Vincent’s Clinical School, University of New South Wales, Sydney, Randwick, NSW 2031, Australia
- Kinghorn Cancer Centre, Department of Medical Oncology, St. Vincent’s Hospital, Darlinghurst, NSW 2010, Australia
| | - Vanessa M. Hayes
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia; (M.C.); (E.K.F.C.); (T.G.); (W.J.); (R.J.L.); (A.-M.H.); (A.M.F.K.); (P.I.C.)
- St. Vincent’s Clinical School, University of New South Wales, Sydney, Randwick, NSW 2031, Australia
- Central Clinical School, University of Sydney, Sydney, Camperdown, NSW 2050, Australia
| |
Collapse
|
44
|
68Ga-Prostate-Specific Membrane Antigen PET/CT Findings in Extra-axial Metastasis From Prostate Carcinoma. Clin Nucl Med 2020; 45:e85-e87. [PMID: 31833925 DOI: 10.1097/rlu.0000000000002866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 67-year-old man with no previous history of malignancy presented with trigeminal neuralgia. MRI of the brain revealed extra-axial lesion along right trigeminal nerve suggestive of neuroma. On histopathology, the lesion was found to be metastasis from adenocarcinoma prostate. Patient underwent Ga-prostate-specific membrane antigen PET/CT for assessing the whole-body status of the disease, which revealed primary prostate lesion, metastatic bone lesions, and extra-axial lesion along the right trigeminal nerve. Extra-axial, intracranial metastasis from prostate carcinoma is an uncommon phenomenon. We describe Ga-prostate-specific membrane antigen PET/CT findings in an exceedingly rare case of extra-axial metastatic lesion from prostate carcinoma.
Collapse
|
45
|
Bhambhvani HP, Greenberg DR, Srinivas S, Hayden Gephart M. Prostate Cancer Brain Metastases: A Single-Institution Experience. World Neurosurg 2020; 138:e445-e449. [PMID: 32147556 DOI: 10.1016/j.wneu.2020.02.152] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/23/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Brain metastases from prostate cancer are rare and poorly described. We sought to assess the proportion of brain metastases arising from prostate cancer and to detail clinical characteristics, treatment modalities, and survival outcomes. METHODS We retrospectively identified and reviewed the charts of 31 patients with intraparenchymal brain metastases from prostate adenocarcinoma seen at our institution from 2008 to 2018. RESULTS Among all patients with brain metastases, the proportion originating from prostate adenocarcinoma was 0.86%. The median age at the time of brain metastasis diagnosis was 69 (range, 57-90). The median original Gleason score was 8 (range, 6-10), and the median prostate-specific antigen at the time of brain metastasis was 60 ng/mL (range, 0.34-4600). The median months from initial cancer diagnosis to brain metastasis was 81 (range, 3-195). The median number of brain metastases was 2 (range, 1-5). Patients had concurrent metastases to bone (100%), lung (48%), and liver (35%). Median overall survival was 3 months (range, 0.4-25.0). Treatment of the brain metastases was correlated with an increase in median survival from 1.2 months to 4.6 months with radiosurgery (hazard ratio = 0.11, P = 0.001) and surgical resection plus radiotherapy to 13 months (hazard ratio = 0.05, P < 0.001). All patients died of advanced, systemic disease and not of their intracranial disease. CONCLUSIONS Brain metastasis from prostate cancer constitutes a small fraction of total brain metastases, but is associated with poor prognosis and is seen in the setting of advanced, castrate resistant disease. These data enable treating physicians to appropriately counsel their patients with prostate adenocarcinoma brain metastasis.
Collapse
Affiliation(s)
- Hriday P Bhambhvani
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Daniel R Greenberg
- Department of Urology, Stanford University Medical Center, Stanford, California, USA
| | - Sandy Srinivas
- Division of Medical Oncology, Stanford University Medical Center, Stanford, California, USA
| | - Melanie Hayden Gephart
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA.
| |
Collapse
|
46
|
Shida Y, Hakariya T, Miyata Y, Sakai H. Three cases of brain metastasis from castration-resistant prostate cancer. Clin Case Rep 2020; 8:96-99. [PMID: 31998495 PMCID: PMC6982515 DOI: 10.1002/ccr3.2587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/08/2019] [Accepted: 10/22/2019] [Indexed: 12/17/2022] Open
Abstract
Brain metastasis from prostate cancer may be becoming more common and may be associated with occurrence of diffuse systemic metastases.
Collapse
Affiliation(s)
- Yohei Shida
- Department of UrologyNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Tomoaki Hakariya
- Department of UrologyNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Yasuyoshi Miyata
- Department of UrologyNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Hideki Sakai
- Department of UrologyNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| |
Collapse
|
47
|
EGR1 regulates angiogenic and osteoclastogenic factors in prostate cancer and promotes metastasis. Oncogene 2019; 38:6241-6255. [PMID: 31312026 PMCID: PMC6715537 DOI: 10.1038/s41388-019-0873-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 03/18/2019] [Accepted: 04/07/2019] [Indexed: 12/21/2022]
Abstract
Early growth response-1 (EGR1) is a transcription factor correlated with prostate cancer (PC) progression in a variety of contexts. For example, EGR1 levels increase in response to suppressed androgen receptor signaling or loss of the tumor suppressor, PTEN. EGR1 has been shown to regulate genes influencing proliferation, apoptosis, immune cell activation, and matrix degradation, among others. Despite this, the impact of EGR1 on PC metastatic colonization is unclear. We demonstrate using a PC model (DU145/RasB1) of bone and brain metastasis that EGR1 expression regulates angiogenic and osteoclastogenic properties of metastases. We have shown previously that FN14 (TNFRSF12A) and downstream NF-κB signaling is required for metastasis in this model. Here we demonstrate that FN14 ligation also leads to NF-κB-independent, MEK-dependent EGR1 expression. EGR1-depletion in DU145/RasB1 cells reduced both the number and size of metastases but did not affect primary tumor growth. Decreased EGR1 expression led to reduced blood vessel density in brain and bone metastases as well as decreased osteolytic bone lesion area and reduced numbers of osteoclasts at the bone-tumor interface. TWEAK (TNFSF12) induced several EGR1-dependent angiogenic and osteoclastogenic factors (e.g. PDGFA, TGFB1, SPP1, IL6, IL8, and TGFA, among others). Consistent with this, in clinical samples of PC, the level of several genes encoding angiogenic/osteoclastogenic pathway effectors correlated with EGR1 levels. Thus, we show here that EGR1 has a direct effect on prostate cancer metastases. EGR1 regulates angiogenic and osteoclastogenic factors, informing the underlying signaling networks that impact autonomous and microenvironmental mechanisms of cancer metastases.
Collapse
|
48
|
|
49
|
Dieterly AM, Uzunalli G, Kemet CM, Soepriatna AH, Goergen CJ, Lyle LT. Epithelial-mesenchymal Transition Phenotypes in Vertebral Metastases of Lung Cancer. Toxicol Pathol 2019; 47:515-527. [PMID: 31064271 DOI: 10.1177/0192623319838491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Vertebral metastases of non-small cell lung cancer (NSCLC) are frequently diagnosed in the metastatic setting and are commonly identified in the thoracic vertebrae in patients. Treatment of NSCLC bone metastases, which are often multiple, is palliative, and the median survival times are 3 to 6 months. We have characterized spontaneous vertebral metastases in a brain metastases model of NSCLC and correlated these findings with epithelial-mesenchymal transition (EMT). Brain metastases were established in athymic nude mice following intracardiac injection of brain-seeking adenocarcinoma NSCLC cells. Thirty-nine percent of mice (14/36) developed spontaneous vertebral metastases, spinal cord compression, and hind-limb paralysis. Vertebral metastases consisted of an adenocarcinoma phenotype with neoplastic epithelial cells arranged in cords or acini and a mesenchymal phenotype with spindloid neoplastic cells arranged in bundles and streams. Quantitative and qualitative immunohistochemical and immunofluorescence assays demonstrated an increase in vimentin expression compared to cytokeratin expression in vertebral metastases. A correlation with EMT was supported by an increase in CD44 in vertebral metastases and parenchymal metastases. These data demonstrate a translational lung cancer metastasis model with spontaneous vertebral metastasis. The mesenchymal and epithelial phenotype of these spontaneous metastases coupled with EMT provide a conduit to improve drug delivery and overall patient survival.
Collapse
Affiliation(s)
- Alexandra M Dieterly
- 1 Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
| | - Gozde Uzunalli
- 1 Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
| | - Chinyere M Kemet
- 1 Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
| | - Arvin H Soepriatna
- 2 Weldon School of Biomedical Engineering, Purdue University College of Engineering, West Lafayette, Indiana, USA
| | - Craig J Goergen
- 2 Weldon School of Biomedical Engineering, Purdue University College of Engineering, West Lafayette, Indiana, USA.,3 Purdue University Center for Cancer Research, West Lafayette, Indiana, USA
| | - L Tiffany Lyle
- 1 Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA.,3 Purdue University Center for Cancer Research, West Lafayette, Indiana, USA.,4 Center for Comparative Translational Research, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
| |
Collapse
|
50
|
Prostatic adenocarcinoma CNS parenchymal and dural metastases: alterations in ERG, CHD1 and MAP3K7 expression. J Neurooncol 2019; 142:319-325. [PMID: 30656528 DOI: 10.1007/s11060-019-03099-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/10/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Prostatic carcinoma metastatic to dura is commonly encountered at autopsy, but presenting as a dural or, especially parenchymal, brain metastasis during life is far less common. Our group has been interested in two immunohistochemical (IHC) markers previously shown to be downregulated in particularly aggressive primary prostatic carcinomas: CHD1 and MAP3K7. Here we assess protein expression in clinically-relevant CNS metastases. We also assessed how these two markers correlated with the most common genetic alteration in prostate cancer: TMPRSS2 fusion to ERG (40-60% of carcinomas at the primary site), which places ERG expression under the control of the androgen-regulated TMPRSS2 gene, increasing expression. DESIGN Database query, 2000-2016, identified 16 metastases to dura, 5 to brain parenchyma. RESULTS Four of five intraparenchymal metastases and 15/16 informative dural-based metastases were ERG-negative (90.5% overall). There was reduced expression of CHD1 in 8/21 and reduced MAP3K7 in 17/21 cases; 7/19 (37%) ERG-negative metastases had dual low expression of CHD1/MAP3K7. ERG-positive cases had high expression of one or both markers. CONCLUSION Metastatic prostatic carcinoma to CNS demonstrates expression patterns consistent with particularly aggressive behavior. Lower ERG expression in dural and intraparenchymal metastases suggests a possibility that ERG-negative tumors with loss of MAP3K7 may become resistant to standard therapies and diffusely metastasize.
Collapse
|