Meningeal Carcinomatosis in Metastatic Prostate Cancer: A Case Report

Meningeal Carcinomatosis in Metastatic Prostate Cancer: A Case Report Eddie Reed, MD, Douglas Matthews, NP, Valerie Dyer, RN, and William D. Figg, PharmD Medicine Branch, National Cancer Institute, Bethesda, Maryland, U.S.A.

ABSTRACT Leptomeningeal involvement of metastatic prostate cancer is a rare clinical entity. We report such a case, along with a summary of three previous cases where detailed clinical information is available. Seven additional cases (for a total of 10 cases) have been reported previously in the literature. It seems that this syndrome is associ-

ated with changes in mentation, specifically without cranial nerve findings on physical exam. The physician should be alerted to the possibility of this clinical circumstance in metastatic prostate cancer patients with altered mental status.

INTRODUCTION

where systemic therapy was causing shrinkage of soft tissue disease, as assessed by computed tomography (CT) scan. Disease shrinkage in the periphery was related to treatment with the novel antiangiogenic agent, carboxy amido triazole.

Meningeal carcinomatosis is a major complication of systemic malignancy. It may present as a part of a terminal illness situation, as an initial manifestation of malignancy, or at any point during the course of the disease (1). The incidence of meningeal carcinomatosis may vary according to tumor type. Whereas it is not uncommon in lymphoma, leukemia, breast cancer, or melanoma, there are some malignancies in which clinical involvement of the leptomeninges is unusual, such as adenocarcinoma of the prostate. The clinical presentation of meningeal carcinomatosis may vary, but the classic signs and symptoms include objective findings on neurologic exam, as well as headache and altered mentation (1,2). Although objective findings on neurologic exam are common in prostate cancer patients with cord compression in the low neuraxis (3), objective evidence of leptomeningeal involvement is uncommon in patients with this disease. Herein, we report a case of a patient with metastatic, androgen-independent prostate cancer who developed meningeal carcinomatosis. This development occurred during a period

Address correspondence and reprint requests to: Clinical Pharmacokinetics Unit, Developmental Therapeutics Department, Medicine Branch, National Cancer Institute, Building 10, Room 5A01, Bethesda, Maryland 20892, U.S.A. © 1999, Blackwell Science, Inc. 1095-5100/99/$14.00/0 The Prostate Journal, Volume 1, Number 2, 1999 99–102

REPORT OF THE CASE An 80-year-old white male was referred to the National Cancer Institute (NCI) in late January 1998 with a history of metastatic prostate cancer. The diagnosis of stage D2 adenocarcinoma of the prostate initially was made in November 1990 based on a transrectal biopsy. The Gleason grade was 8 of 10, the prostate specific antigen (PSA) level was 110 ng/ml, and the bone scan was positive in multiple sites. Lupron and flutamide therapies were initiated, and the PSA level fell to