# Rare Multiple Brain Metastases Following Debulking Surgery and Androgen Deprivation Therapy in Aggressive Prostate Cancer-Case Report

## TL;DR

A rare case of aggressive prostate cancer leading to multiple brain metastases is reported, highlighting the need for comprehensive evaluations and multimodal treatment.

## Contribution

This case report highlights the rare occurrence of brain metastases in prostate cancer following initial successful treatment.

## Key findings

- A patient with prostate cancer developed multiple brain metastases after 4 years of low PSA levels.
- Multimodal treatment including surgery, radiotherapy, and endocrine therapy is effective for brain metastases.
- Comprehensive evaluations are crucial to detect rare metastatic sites in advanced prostate cancer.

## Abstract

In clinical practice, approximately 80% of prostate cancer (PC) cases are localized and can achieve favorable outcomes with appropriate treatment. Conversely, some remaining cases exhibit an aggressive phenotype or develop resistance to therapeutic interventions, leading to tumor metastasis and a poorer prognosis. When PC metastasizes to distant sites, the bone remains the predominant location, and brain metastases are regarded as exceedingly rare.

The current study focused on a rare clinical PC case that presented multiple brain metastases after prostate surgery. The patient was initially diagnosed with PC through prostate biopsy and subsequently underwent prostate debulking surgery while continuing androgen deprivation therapy, which maintained low prostate-specific antigen (PSA) levels for 4 years. However, a sudden PSA surge to 7.858 ng/mL led to the emergence of two brain metastatic tumors, which were confirmed to have originated from the prostate.

Patients with advanced PC require comprehensive evaluations to detect rare metastatic sites, such as the brain, to avoid missed diagnoses. For patients with brain metastases, a multimodal approach combining surgical resection, postoperative radiotherapy, and endocrine therapy can effectively alleviate symptoms and enhance survival.