A case report of prostate cancer with leptomeningeal metastasis and bone marrow involvement

TL;DR

This case report describes a rare instance of prostate cancer spreading to the brain and bone marrow, and the patient's positive response to a combination therapy.

Contribution

The novelty lies in the successful use of triplet therapy (docetaxel, abiraterone, and androgen deprivation) for leptomeningeal prostate cancer.

Findings

The patient showed improvement in blood counts and CNS symptoms after 11 months of treatment.

Combination therapy may improve outcomes in rare cases of leptomeningeal prostate cancer.

Leptomeningeal involvement is rare but should be considered in patients with progressive CNS symptoms.

Abstract

Prostate cancer is the second most common cancer in men. Central nervous system (CNS) involvement in prostate cancer which manifests as cerebral, leptomeningeal, or dural involvement is uncommon and occurs late in the course of disease.

A 60‐year‐old patient with castration resistant prostate cancer (CRPC) presented with headache and fatigue. Evaluation revealed bone marrow and leptomeningeal involvement. The patient treated by whole brain radiotherapy, leuprolide, weekly docetaxel and daily 1000 mg abiraterone. Complete blood count (CBC) and CNS symptoms improved and the patient is alive after 11 months with excellent performance status.

Leptomeningeal involvement in prostate cancer is rare and is associated with a poor prognosis but the possibility of such event should be considered in patients with new onset progressive CNS symptoms. New treatment strategies such as combination of docetaxel and abiraterone added to androgen deprivation therapy (triplet therapy) might improve outcome in these patients.

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