Stereotactic radiosurgical treatment of parenchymal brain metastases from prostate adenocarcinoma

BackgroundProstate cancer metastatic to the brain is uncommon and has been associated historically with a poor prognosis. It has been suggested that SRS may be an effective treatment.MethodsWe analyzed a prospective, institutional review board–approved database of patients treated with SRS and identified 5 patients with prostate cancer metastasis. Clinical, pathologic, radiographic, treatment, and outcome information regarding the primary/systemic disease status, and brain metastases were collected.ResultsMean age at the time of treatment for CNS parenchymal metastasis was 72.0 ± 8.3 years and lesions developed 82.0 ± 65.1 months after the initial tumor was identified. Four patients had a single lesion and 1 had 4; 3 patients were treated with SRS alone, 1 with WBRT and SRS, and 1 with surgery, then WBRT and SRS. All were symptomatic. Stereotactic radiosurgery controlled the brain metastases in all 5 patients, with functional improvement and with a typical increase of 1 grade in the Karnofsky performance score. Mean survival was at least 10.0 ± 6.7 months (range, 6-22+ months). Two patients died of conditions unrelated to prostate cancer and 2 of systemic disease progression; 1is alive and asymptomatic. There were no local SRS failures and no new CNS lesions.ConclusionsStereotactic radiosurgery for prostate cancer metastatic to the brain, alone or in combination with brain radiation therapy and surgery, is a safe, effective treatment that improves neurologic symptoms and function and may prolong survival.