Solitary Brain Metastasis From Prostate Cancer: A Case Report
Tasneem Barakat, Arnav Agarwal, Rachel McDonald, Vithusha Ganesh, Sherlyn Vuong, Michael Borean, Edward Chow, Hany Soliman
Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Correspondence to:
Abstract: Brain metastases arising from prostate cancer are exceedingly rare and typically occur late in the course of the disease. Most patients have widespread metastatic disease before developing brain metastases from prostate cancer. We report the case of a 67-year-old male with prostate cancer presenting with an isolated symptomatic brain metastasis. Aggressive treatment of the metastatic site included tumor resection and adjuvant stereotactic radiation treatment to the surgical bed, resulting in a favorable outcome.
Keywords: Brain brain metastases metastatic cancer prostate cancer stereotactic radiosurgery radiotherapy
Submitted Mar 06, 2016. Accepted for publication Apr 16, 2016.
doi: 10.21037/apm.2016.04.02
Bone Metastases Life Expectancy
In the advanced stages of cancer, tumor cells may spread from the affected organ to different parts of the body, including the brain, liver, bones, etc. This process is called metastasis, and it occurs when cancer cells are released to the bloodstream, allowing them to freely invade other organs. The most common site of bone metastasis is the spine. Other sites include the hip, the upper leg, the upper arm, the ribs, and skull. Once cancer spreads to the bones, cure can be difficult. With bone metastases, life expectancy can be shortened, but there are ways of helping a patient feel more comfortable and improve the quality of life.
Drugs To Treat Cancer Spread To Bone
If prostate cancer spreads to other parts of the body, it almost always goes to the bones first. These areas of cancer spread can cause pain and weak bones that might break. Medicines that can help strengthen the bones and lower the chance of fracture are bisphosphonates and denosumab. Sometimes, radiation, radiopharmaceuticals, or pain medicines are given for pain control.
Side effects of bone medicines
A serious side effect of bisphosphonates and denosumab is damage to the jaw, also called osteonecrosis of the jaw . Most people will need to get approval from their dentist before starting one of these drugs.
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How Prostate Cancer Spreads
Cancer cells sometimes break away from the original tumor and go to a blood or lymph vessel. Once there, they move through your body. The cells stop in capillaries — tiny blood vessels — at some distant location.
The cells then break through the wall of the blood vessel and attach to whatever tissue they find. They multiply and grow new blood vessels to bring nutrients to the new tumor. Prostate cancer prefers to grow in specific areas, such as lymph nodes or in the ribs, pelvic bones, and spine.
Most break-away cancer cells form new tumors. Many others don’t survive in the bloodstream. Some die at the site of the new tissue. Others may lie inactive for years or never become active.
Where Can I Find Support
It can be very difficult to deal with a diagnosis of advanced prostate cancer. Its natural to wonder if youre doing all you can to fight the cancer and how to handle guilt, intimacy with a partner, and concerns about masculinity. And finding and paying for the best care can, of course, be a challenge.
But emotional and practical support can help you move forward. An important thing to remember is that youre not alone. There are many kinds of help available, and the right cancer resources can make a world of difference.
Ask your doctor for resources you can contact, including social workers and support systems in your community. The Patient Navigator Program of the ACS can be reached at 1-800-227-2345 youll be connected to a patient navigator at a cancer treatment center who can help you with practical and emotional issues.
The Prostate Cancer Foundation has links to in-person and online support groups around the country, and the ACS lists nationwide support programs as well. The PCF also offers resources ranging from help with housing during cancer treatment to finding ways you can look good and feel better while living with cancer.
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How Will My Cancer Be Monitored
Your doctor will talk to you about how often you should have check-ups. At some hospitals, you may not have many appointments at the hospital itself. Instead, you may talk to your doctor or nurse over the telephone. You might hear this called self-management.
You will have regular PSA tests. This is often a useful way to check how well your treatment is working. Youll also have regular blood tests to see whether your cancer is affecting other parts of your body, such as your liver, kidneys or bones.
You might have more scans to see how your cancer is responding to treatment and whether your cancer is spreading.
Your doctor or nurse will also ask you how youre feeling and if you have any symptoms, such as pain or tiredness. This will help them understand how youre responding to treatment and how to manage any symptoms. Let them know if you have any side effects from your treatment. There are usually ways to manage these.
How Does Prostate Cancer Kill You In The End
Prostate cancer is the most common cancer after skin cancer in men in the US and the second leading cause of cancer death. Prostate-specific antigen testing has made the detection of prostate cancer easier in its early stages. Ninety-two out of 100 men get diagnosed when the cancer is limited to the prostate.
Most men are diagnosed with prostate cancer in their senior years and only 1 out of 36 men die from it. Death from prostate cancer most often happens when cancer has spread to other organs in the body. This is known as the advanced stage of prostate cancer.
The chances of survival decrease as cancer spreads beyond the prostate. If cancer has metastasized to other parts of the body, only three out of 10 men will survive for five years after the diagnosis.
Advanced stage prostate cancer or metastasized prostate cancer
Cancerous cells may spread to organs other than the site of origin. In the case of prostate cancer, this tendency is decreased, but it can happen. Advanced stage prostate cancer is defined based on the Gleason score, which is based on the TNM staging of cancer. T stands for tumor size, N stands for lymph node involvement and M stands for metastasis.
Prostate cancer can kill in the end through metastases that can develop in
Metastasis to the liver can affect the livers ability to filter out toxins from the body. This can eventually lead to jaundice, nausea, loss of appetite and weight loss.
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What Is Prostate Cancer Bone Metastasis
Prostate cancer bone metastasis occurs when prostate cancer spreads to the bones. When prostate cancer does spread outside of the prostate itself, bones are among the most common organs they first spread to. Prostate cancer bone metastasis occurs slightly more often than breast cancer bone metastasis, as over 60% of men suffering from advanced prostate cancer will eventually develop bone metastasis.
Urinary Problems After Surgery
Leaking urine
Most men cant control their bladder properly when their catheter is first removed. This is because surgery can damage the muscles and nerves that control when you urinate.You might just leak a few drops if you exercise, cough or sneeze . Or you might leak more and need to wear absorbent pads, especially in the weeks after your surgery.Leaking urine usually improves with time. Most men start to see an improvement one to six months after surgery. Some men leak urine for a year or more and others never fully recover, but there are things that can help and ways you can manage it.
Difficulty urinating
A few men may find it difficult to urinate after surgery . This can be caused by scarring around the opening of the bladder or the urethra .Some men find they suddenly and painfully cant urinate. This is called acute urine retention and it needs treating quickly to prevent further problems. If this happens, call your doctor or nurse, or go to your nearest accident and emergency department.
Watch Paulâs story for one manâs experience of managing urinary problems after surgery below.
Sexual problems after surgery
Change in penis size and shape
Changes to orgasm
The seminal vesicles, which make some of the fluid in semen, are removed during surgery. This means you wont ejaculate any more. You may have a dry orgasm instead where you feel the sensation of orgasm but dont ejaculate. This may feel different to the orgasms youre used to.
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Can Prostate Cancer Spread
Medically Reviewed by: Dr. BautistaUpdated on: November 18, 2019
Like other cancers, prostate cancer can spread if the cancer cells grow out of control. At ITC, we treat all different types of cancer and know that patients often have a lot of questions surrounding their diagnosis.
We often are asked what is prostate cancer? Can prostate cancer spread? How is it diagnosed? And more. At Immunity Therapy Center, we know that each diagnosis is unique and every patient is different which is why we focus on a holistic approach to prostate cancer. And we believe that when patients have the knowledge, theyre more likely to take control of their health.
To give you the knowledge to prepare, lets take a closer look at prostate cancer, what symptoms to look for, and how it can spread.
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Receiving Treatment For Prostate Cancer That Has Spread
At Moffitt Cancer Center, the experts within our Urologic Oncology Program treat patients with all stages of prostate cancer, including advanced-stage cancers that have metastasized to other areas of the body. Our multispecialty team collaborates as a tumor board, ensuring each patient receives a treatment plan tailored to his unique needs. For individuals with metastatic prostate cancer, treatment plans aim to alleviate symptoms, slow the rate of cancer growth and shrink tumors to help improve quality of life.
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How To Spot Prostate Cancer Early
There are two types of screening that your doctor may recommend: the first requires blood collection to measure the level of the prostate-specific antigen PSA. Higher levels often indicate the presence of prostate cancer.
The second test is a physical examination in which a doctor puts on gloves, lubricates the finger and inserts it into the rectum to see if the prostate is enlarged. If any of the results indicate the possibility of prostate cancer, your doctor will recommend further tests.
âEarly-stage prostate cancer typically does not have any physical signs or symptoms,â said Dr. Salim Cheriyan, a urologist with Baylor St. Lukeâs Medical Group. âThis is why discussing the risks and benefits of screening with your physician is an important part of detecting prostate cancer.â
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What Is The Treatment For Advanced Prostate Cancer
No matter where prostate cancer spreads, its still treated as prostate cancer. Its harder to treat when it reaches an advanced stage.
Treatment for advanced prostate cancer involves targeted and systemic therapies. Most men need a combination of treatments and they may have to be adjusted from time to time.
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Finding Out If The Cancer Has Spread
To find out if cancer has spread outside of the prostate, doctors may perform the imaging tests listed below. Doctors are able to estimate the risk of spread, called metastasis, based on PSA levels, tumor grade, and other factors, but an imaging test can confirm and provide information about the cancers location.
Imaging tests may not always be needed. A CT scan or bone scan may not be necessary for those with no symptoms and low-risk, early-stage prostate cancer, as determined with information from the PSA test and biopsy. Learn more about when these tests are recommended to find out if the cancer has spread.
For people with advanced prostate cancer, ASCO recommends that 1 or more of the imaging tests below be done to provide more information about the disease and help plan the best treatment. This includes when there is a newly diagnosed, high-risk cancer if metastasis is suspected or confirmed if the cancer has returned following treatment or when the cancer grows during the treatment period. Learn more about this guideline on the ASCO website.
Magnetic resonance imaging . An MRI scan uses magnetic fields, not x-rays, to produce detailed images of the body. An MRI can be used to measure the tumors size, and a scan can focus specifically on the area of the prostate or on the whole body. A special dye called contrast medium is given before the scan to create a clearer picture, which is injected into a patients vein.
What Is Metastatic Cancer
In metastasis, cancer cells break away from where they first formed , travel through the blood or lymph system, and form new tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor.
Cancer that spreads from where it started to a distant part of the body is called metastatic cancer. For many types of cancer, it is also called stage IV cancer. The process by which cancer cells spread to other parts of the body is called metastasis.
When observed under a microscope and tested in other ways, metastatic cancer cells have features like that of the primary cancer and not like the cells in the place where the metastatic cancer is found. This is how doctors can tell that it is cancer that has spread from another part of the body.
Metastatic cancer has the same name as the primary cancer. For example, breast cancer that spreads to the lung is called metastatic breast cancer, not lung cancer. It is treated as stage IV breast cancer, not as lung cancer.
Sometimes when people are diagnosed with metastatic cancer, doctors cannot tell where it started. This type of cancer is called cancer of unknown primary origin, or CUP. See the Carcinoma of Unknown Primary page for more information.
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Experiments With Tissue Culture & Animal Models Of Prostate Cancer
Experiments with tissue culture and animal models of prostate cancer have revealed the mechanisms of the synthesis of lymphangiogenic growth factors in prostate cancer and their important contribution to lymphangiogenesis in prostate cancer lymph node metastasis.
Signaling pathways for VEGF-C synthesis in prostate cancer
Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission can be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. Although there are treatments to help prevent a recurrence, such as hormonal therapy and radiation therapy, it is important to talk with your doctor about the possibility of the cancer returning. There are tools your doctor can use, called nomograms, to estimate someones risk of recurrence. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
In general, following surgery or radiation therapy, the PSA level in the blood usually drops. If the PSA level starts to rise again, it may be a sign that the cancer has come back. If the cancer returns after the original treatment, it is called recurrent cancer.
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence, including where the recurrence is located. The cancer may come back in the prostate , in the tissues or lymph nodes near the prostate , or in another part of the body, such as the bones, lungs, or liver . Sometimes the doctor cannot find a tumor even though the PSA level has increased. This is known as a PSA-only or biochemical recurrence.
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What Is Prostate Cancer
Cancer can start any place in the body. Prostate cancer starts in the prostate gland. It starts when cells in the prostate grow out of control.
Cancer cells can spread to other parts of the body. Cancer cells in the prostate can sometimes travel to the bones or other organs and grow there. When cancer cells do this, its called metastasis. To doctors, the cancer cells in the new place look just like the ones from the prostate.
Cancer is always named for the place where it starts. So when prostate cancer spreads to the bones , its still called prostate cancer. Its not called bone cancer unless it starts from cells in the bone.
Ask your doctor to use this picture to show you where your cancer is.
The prostate
The prostate is a gland found only in men, so only men can get prostate cancer.
The prostate is just below the bladder and in front of the rectum . The tube that carries pee goes through the prostate. The prostate makes some of the fluid that helps keep the sperm alive and healthy.
There are a few types of prostate cancer. Some are very rare. Most prostate cancers are a type called adenocarcinoma. This cancer starts from gland cells. Your doctor can tell you more about the type you have.
What Will Happen In The Last Few Days
It can help to know what is normal in the last few days of life so that you know what to expect. You might not be aware of these changes when they happen because you may be drowsy or unconscious.
If youre supporting someone who is dying, read about what you can do to help and how you can get support.
Pain
Many people worry about being in pain when they are dying. Some people do get pain if their prostate cancer presses on their nerves or makes their bones weak. But not everyone dying from prostate cancer has pain. And if you are in pain, there are things that can help to reduce and manage pain.
You should tell your doctor or nurse if youre in pain or if your pain gets worse. They can talk with you about how best to manage your pain and can help keep it under control.
You may find sitting or lying in some positions more comfortable than others, so ask if you need help getting into a different position.
Your doctor can give you medicines to help manage pain. The type of medicines they give you will depend on what is causing the pain and which medicines are suitable.
Your doctor will monitor how the pain medicines are working and may change the type of medicine or the dose. If youre still in pain or get pain in between taking medicines, its important to tell your doctor or nurse.
Sleeping and feeling drowsy
Changes in skin temperature or colour
Changes in breathing
Changes in urinating or bowel movements
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