# Survival outcomes and clinical characteristics of brain metastases from prostate cancer: A single-center analysis

## TL;DR

Brain metastases from prostate cancer are rare and occur in advanced cases, often with other metastases and poor survival outcomes.

## Contribution

This study provides a detailed analysis of clinical features and survival outcomes for a rare condition: brain metastases from prostate cancer.

## Key findings

- Median overall survival after brain metastasis diagnosis was 9.4 months.
- Most patients had castrate-resistant prostate cancer and concurrent metastases.
- Treatment modality did not significantly affect survival outcomes.

## Abstract

Brain metastases (BrM) from prostate cancer (PC) are rare. This study sought to evaluate their prevalence, clinical features, treatment modalities, and survival outcomes.

From a database of BrM patients, we analyzed 28 cases of prostate cancer treated at our center between 2008 and 2023.

BrM from PC comprised 0.7% of cases. The majority of patients had high-risk features at PC diagnosis: median prostate-specific antigen (PSA) at diagnosis was 65.5 ng/ml (range: 3.9–784.7 ng/ml), 82% were Gleason grade group ≥ 4, and 68% had perineural invasion (PNI). At BrM diagnosis, 79% were castrate-resistant. Most patients had concurrent metastases, including bone (94%), lymph nodes (63%), or lung (6%). Fifty percent presented with a single brain lesion, and the median Graded Prognostic Assessment (GPA) score was 1.5 (range: 0.5–2.5). Patients commonly had radiographic brain edema (57%) and neurological symptoms (54%), whereas only 7% had seizures. Median overall survival (OS) was 9.4 months (95% CI: 4.8–14.8 months) after BrM diagnosis. An upward trend in OS was observed with higher GPA (P = .07). Treatment modalities, including surgery with adjuvant radiation, stereotactic radiosurgery, and whole brain radiotherapy, showed no significant difference in median OS (9.4, 10.1, and 11.0 months respectively, P = .79). OS did not significantly differ between patients with a single versus multiple BrM or patients with castrate-sensitive versus castrate-resistant PC.

BrMs from prostate cancer are rare and predominantly occur in patients with advanced, castrate-resistant disease, often accompanied by other metastases. This analysis enhances our understanding of the disease trajectory and informs treatment discussions.