Neurologic Complications Of Prostate Cancer
RAMSIS BENJAMIN, M.D., M.P.H., Keck School of Medicine of the University of Southern California, Los Angeles, California
Am Fam Physician. 2002 May 1 65:1834-1841.
This article exemplifies the AAFP 2002 Annual Clinical Focus on cancer: prevention, detection, management, support, and survival.
Neurologic complications continue to pose problems in patients with metastatic prostate cancer. From 15 to 30 percent of metastases are the result of prostate cancer cells traveling through Batsonâs plexus to the lumbar spine. Metastatic disease in the lumbar area can cause spinal cord compression. Metastasis to the dura and adjacent parenchyma occurs in 1 to 2 percent of patients with metastatic prostate cancer and is more common in those with tumors that do not respond to hormone-deprivation therapy. Leptomeningeal carcinomatosis, the most frequent form of brain metastasis in prostate cancer, has a grim prognosis. Because neurologic complications of metastatic prostate cancer require prompt treatment, early recognition is important. Physicians should consider metastasis in the differential diagnosis of new-onset low back pain or headache in men more than 50 years of age. Spinal cord compression requires immediate treatment with intravenously administered corticosteroids and pain relievers, as well as prompt referral to an oncologist for further treatment.
More Common Neurologic Complications in Patients with Metastatic Prostate Cancer*
? = unknown.
How Do Healthcare Providers Diagnose Metastatic Brain Tumors
Your healthcare provider may start the diagnosis process by asking about your symptoms such as headaches, blurred vision and nausea. They may ask how long youve had the symptoms and how your symptoms affect you.
For example, if you have headaches, they may ask if your headaches persist even after youve taken medication. They may ask if your headaches are so intense they interrupt your daily routine or if you wake up with headaches that gradually get better as the day goes on.
If youre being treated for cancer, your healthcare provider will ask about that cancer. Cancer cells dont change during metastasis. For example, if you have breast cancer thats spread to your brain, your healthcare provider may treat the cancer in your brain the same way they treat your breast cancer. Heres the sort of information your healthcare provider will use to diagnose your metastatic brain cancer:
- What type of cancer you have.
- When your cancer was diagnosed.
- Your cancers status, meaning the specific stage and grade.
- Your current treatment and how your cancer is responding to that treatment.
Survival Rates For Prostate Cancer
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. These rates cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.
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How To Tell If Your Cancer Has Metastasized
Prostate cancer metastasis may be suspected if you have specific symptoms such as new lower back pain or elevated liver enzymes. These may be signs your cancer has spread to your spine or your liver, respectively. If your prostate-specific antigen levels continue to rise despite treatment, especially if they are rising particularly fast, this may be a sign that cancer is metastasizing somewhere in your body.
Prostate Cancer Is Common With Aging
After skin cancer, prostate cancer is the most common cancer in men. About 1 in 7 men will be diagnosed with prostate cancer in their lifetime. And these are just the men who are diagnosed. Among very elderly men dying of other causes, a surprising two-thirds may have prostate cancer that was never diagnosed.
Only 1 in 36 men, though, actually dies from prostate cancer. Thatâs because most prostate cancers are diagnosed in older men in whom the disease is more likely to be slow-growing and non-aggressive. The majority of these men eventually pass away from heart disease, stroke, or other causes â not their prostate cancer.
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What Are The Differences Between A Metastatic Brain Tumor And A Primary Brain Tumor
There are several differences between a metastatic or secondary brain tumor and a primary brain tumor. Some differences are:
- A primary brain cancer is a tumor that develops in your brain. A metastatic or secondary brain tumor happens when cancer spreads to your brain from another area of your body.
- A metastatic brain tumor is malignant, and most primary brain tumors are benign. However, benign brain tumors can affect how your brain functions if they grow large enough to press on nearby nerves, blood vessels and brain tissue.
- Metastatic brain tumors are more common than primary brain tumors.
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.
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Strength Of The Study
The current case report is unique in many ways, based on the CT and MR images. These include the initial intraventricular hemorrhage, acute hydrocephalus, and a large exophytic hemorrhagic metastasis from the hypothalamus extended to the suprasellar cistern, with the morphology suggestive of a giant thrombotic aneurysm. In this case, the lesions location being adjacent to the hypothalamus, peripheral parenchymal edema, lack of subarachnoid hemorrhage, and lack of visible feeding artery were the helpful information to exclude a possible aneurysm. Lastly, the hypernatremia found in this case was likely due to the patients history of diabetes insipidus. To the best of knowledge, this is the first case of exophytic hypothalamic prostatic metastasis that mimicked a ruptured aneurysm.
How Do Healthcare Providers Treat Brain Metastases
Your healthcare provider may begin by treating your immediate symptoms. For example, if you have edema from your brain tumor, your healthcare provider might prescribe steroids. If youve had seizures, they might prescribe anticonvulsant medication.
The overarching treatment for metastatic brain tumors is to stop or slow the tumors growth in your brain and minimize your symptoms while treating the cancer thats spread to your brain.
Whats the treatment for breast cancer metastasis to my brain?
Healthcare providers may combine ongoing breast cancer treatment with the following treatments:
Whats the treatment for lung metastasis to my brain?
Healthcare providers use radiosurgery and/or brain surgery to treat lung metastasis to your brain. Recent research shows small cell lung cancer in the brain may be sensitive to targeted therapies and immunotherapy.
Whats the treatment for melanoma metastasis to my brain?
Healthcare providers may use radiosurgery and/or surgery and immunotherapy to treat melanoma metastasis to your brain.
Whats the treatment for prostate metastasis to my brain?
Metastatic brain tumors stemming from your prostate are very rare, accounting for about 1% of all metastatic brain cancers. Prostate cancer that has spread to your brain may be treated with radiosurgery and/or surgery.
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Radiation Therapy For Metastatic Brain Tumors
Radiation therapy treats metastatic brain tumors by using X-rays and other forms of radiation to destroy cancer cells or prevent a tumor from growing. It is also called radiotherapy.
These painless treatments involve passing beams of radiation through the brain, which can treat cancers in areas that are difficult to reach through surgery. Procedures may include any one or a combination of the following:
- External beam radiation therapy delivers radiation from a machine and through the body to reach metastatic tumors.
- Whole-brain radiation targets the entire brain to hit multiple tumors or any metastatic disease that hides from an MRI scan.
- Stereotactic radiosurgery directs a high dose of radiation targeted to the specific shape of the tumor, sparing surrounding healthy tissue from unnecessary radiation exposure.
- Proton therapy uses protons to treat metastatic brain tumors. Like stereotactic radiosurgery, proton therapy minimizes harm to healthy tissue surrounding a tumor.
These procedures may be performed after surgery to prevent tumors from recurring at the surgical site and growing into other brain tissue.
Because radiation therapy has been so successful in treating brain metastases and because many live long lives after treatment studies are now looking at how to manage the long-term effects of treatment.
Where Does Prostate Cancer Usually Spread First
Once prostate cancer cells start spreading, they are most likely to affect the bones first and foremost. At this point, patients receive the diagnosis of prostate cancer with bone metastases.
This prognosis indicates a stage 4 case of prostate cancer, which is the most advanced type of cancer. When this occurs, patients feel bone pain, and their bones are weakened. The risk of getting bone fractures becomes incrementally higher.
Today, there are no cures to completely treat stage 4 prostate cancer. Nonetheless, patients are recommended to consider palliative care. This type of treatment focuses on pain alleviation and on soothing other symptoms.
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Brain Metastasis From Prostate Small Cell Carcinoma: Not To Be Neglected
Published online by Cambridge University Press: 02 December 2014
- Corrie E. Erasmus
- Affiliation:Department of Neurosurgery, Canisius Wilhelmina Hospital, Nijmegen, The NetherlandsDepartment of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Wim I.M. Verhagen
- Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Carla A.P. Wauters
- Department of Pathology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Erik J. van Lindert
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
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Can Prostate Cancer Spread To The Brain
As in other locations, prognosis in prostatic involvement by leukemia/lymphoma is dependent on the subtype.
The majority of cases are low grade, predominantly chronic lymphocytic leukemia/small lymphocytic lymphoma . As such, the prognosis in these cases is generally favorable. In a large consecutive series with follow-up data, which showed predominantly low-grade leukemia/lymphoma, only one patient had died from disease at follow-up.
In contrast, diffuse large B-cell lymphoma , which is often primary, carries a considerably less favorable prognosis. In a large series of primary prostatic lymphomas to date, which notably included numerous high-grade secondary prostatic lymphomas in survival analysis, 5-year lymphoma-specific survival was only 33%.
References
Terris MK, Hausdorff J, Freiha FS. Hematolymphoid malignancies diagnosed at the time of radical prostatectomy. J Urol. 1997 Oct. 158:1457-9. .
Chu PG, Huang Q, Weiss LM. Incidental and concurrent malignant lymphomas discovered at the time of prostatectomy and prostate biopsy: a study of 29 cases. Am J Surg Pathol. 2005 May. 29:693-9. .
Warrick JI, Owens SR, Tomlins SA. Diffuse large B-cell lymphoma of the prostate. Arch Pathol Lab Med. 2014 Oct. 138 :1286-9. . .
Gajendra S, Sharma R, Sahoo MK. Triple cancer: chronic lymphocytic leukemia with bladder and prostate carcinoma. Malays J Pathol. 2015 Aug. 37 :159-63. . .
What Is A Metastatic Brain Tumor
A metastatic brain tumor is one of several types of metastatic cancer. Brain metastases, or metastatic brain tumors, happen when cancer in one part of your body spreads to your brain. Most metastatic brain tumors spread from primary cancers in your lungs, your breasts or your skin, specifically melanoma.
Researchers are finding more ways to predict who might develop brain metastases so healthcare providers can monitor for signs of metastatic brain tumors. Healthcare providers treat metastatic brain tumors by managing your symptoms through surgery and other treatments and helping you maintain your quality of life.
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Demographic And Clinical Data Of The Pcbm Cohort
The cohort of 51 patients analyzed here , represents a substantial increase in the number of PCBM samples over existing studies. . The average age at the time of PCBM diagnosis among the 51 patients was 71years. 56% harbored multiple and 41% singular CNS metastasis. Metastases in brain parenchyma were present in 41% , dural metastases in 35% while in 24% of the patients the primarily metastatic location was either unknown or unclear by involvement of multiple anatomical structures. Additionally, 88% of the patients presented non-brain metastases with bone involvement in 91% of these. Androgen deprivation therapy or orchiectomy were conducted in 82% of the cases. From those, 26% underwent further therapy with next-generation ARSi , namely abiraterone and/or enzalutamide .
What Is The Metastatic Brain Tumor Prognosis
Your prognosis or expected outcome depends on several factors that are specific to you and your medical condition. Healthcare providers base prognoses on factors such as your age and your overall health. They also consider how your primary cancer responded to treatment, if you have more than one brain tumor and your brain tumors size. Your healthcare provider is your best resource for information about your personal prognosis.
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Is It Time To Let A Dog With Cancer Go
Our canine companions are a member of our family, making a cancer diagnosis extremely devastating. Not only is it difficult to hear the words, but many owners struggle with understanding the process of their disease and when its actually time to let them go. In this article we will help you understand the diagnosis of cancer in dogs.
What Are The Treatments For Metastatic Prostate Cancer
It mainly depends on the stage of your cancer. Metastatic prostate cancer is stage IV, and doctors divide it into two types: IVA and IVB.
If you have stage IVA prostate cancer, that means the disease has spread to nearby lymph nodes but not to distant parts of your body. If youâre healthy enough to get treatment, or if youâre having symptoms from the cancer, your doctor may recommend one of these treatment options:
External beam radiation treatment with androgen deprivation therapy . During EBRT, a machine outside your body sends beams of radiation to your prostate gland. Radiation destroys cancer cells.
ADT is a type of hormone therapy. It involves taking medications to lower the levels of male sex hormones that your testicles make, or getting surgery to remove the testicles. Androgens, like testosterone, often fuel the growth of prostate cancer cells.
Along with ADT, your doctor might also have you take a drug called abiraterone . It helps stop cells in other parts of your body, like your adrenal glands, from making androgens.
ADT with or without abiraterone. If your doctor recommends this option, you wonât need to get external beam radiation treatment along with it.
If you have stage IVB prostate cancer, the disease has spread to distant organs, like your bones. Your doctor can give you treatments that help keep your cancer under control for as long as possible and improve your quality of life.
Some treatment options are:
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