Brain metastases as the first clinical manifestation of prostate cancer: a case report

Abstract

Background. Intracranial metastases, as the first clinical symptom of prostate cancer (PC), are extremely rare, with only anecdotal case reports in the literature. Aim. To present a case of multiple brain metastases (MCI) as the first clinical manifestation of PC with isolated facial nerve injury (FNI). Materials and methods. A 66-year-old patient with PC and multiple brain and bone metastases was observed. Results. The patient considered himself sick for 4 months when weakness in the left arm, headache, dizziness, facial asymmetry, staggering when walking, and memory loss appeared. He received non-surgical treatment prescribed by a neurologist. A clinical examination revealed a neurological deficit in the form of FN central palsy of grade 3 according to the House-Brackmann score. Magnetic resonance imaging of the brain showed masses in the right insular, left temporal lobes, and left cerebellar hemisphere of 3.7×3.3×2.9, 1.1×0.8 and 0.5×0.6 cm, respectively, with marked perifocal edema. According to the magnetic resonance imaging of the pelvis in the right half of the prostate gland, a tumor of 2.2×1.0×2.7 cm and PI-RADS 5 score was detected, and a metastatic lesion of the left ilium was found. Bone scintigraphy showed metastases in the thoracic and lumbar spine. A core biopsy of the prostate was performed. Histological and immunohistochemical studies revealed acinar adenocarcinoma with a Gleason score of 6 (3+3) points. The level of total prostate-specific antigen was 8.6 ng/mL. A final diagnosis was made: stage IV prostate cancer, T2aN0M1c, with brain and bone metastases. Given the neurological symptoms, radiation therapy was performed on the brain with a total radiation dose of 30 Gy, followed by androgen deprivation and monochemotherapy with docetaxel and bisphosphonates. Conclusion. Multiple brain lesions as the first clinical manifestation of PC are extremely rare. An isolated lesion of FN with neurological deficit in the form of central palsy indicates an advanced metastatic process. The primary method of treatment is palliative radiation therapy with a total radiation dose of 30 Gy, followed by androgen deprivation and chemotherapy.