Leptomeningeal Carcinomatosis of Prostate Cancer: A Case Report and Review of the Literature

Abstract

Leptomeningeal carcinomatosis is a rare complication of prostate cancer. It is likely underdiagnosed as suggested by autopsy studies and is expected to become more prevalent with increasing survival of prostate cancer patients. Prostate cancer leptomeningeal carcinomatosis is associated with rapid functional decline and a median survival of approximately 1 month. Diagnosis is challenging because the clinical manifestations are varied, and no gold-standard diagnostic approach exists. Treatment of prostate cancer leptomeningeal carcinomatosis is not standardized and multiple approaches have been reported, mostly as case studies. Herein we report a case of a 73-year-old patient with metastatic castration-resistant prostate cancer who presented to our clinic with subacute cognitive decline, ataxia, and urinary incontinence, and was found to have leptomeningeal carcinomatosis.

Keywords: Central nervous system metastasis; Leptomeningeal carcinomatosis; Prostate cancer.

Figure 1.

Brain MRI images of our patient with prostate cancer leptomeningeal carcinomatosis. (A) Post-contrast T1 coronal imaging demonstrates enhancement of leptomeninges in the basal cistern and dilatation of the lateral ventricles. (B) Post-contrast T1 axial imaging demonstrates enhancement of the leptomeninges in the bilateral Sylvian fissures and surface of the brainstem. (C) Axial FLAIR imaging demonstrates rounded margin of the dilated lateral ventricles with high FLAIR signal rim at the periventricular ependymal surface, suggesting active hydrocephalus.