Metastatic Prostate Carcinoma and Skull Base Pathology

Introduction: After breast and lung cancer, prostate carcinoma is the most frequent cause of metastatic tumor to the cranium. The tendency to metastasize to bone increases the likelihood that skull base lesions are related to prostate carcinoma. Skull base involvement frequently produces neuro-ophthalmic signs and symptoms.

Materials and Methods: A retrospective review of patients with prostate carcinoma presenting with neuro-ophthalmic manifestations.

Results: 20 patients with known prostate carcinoma presented with neuro-ophthalmic signs and symptoms. In the majority of cases the prostate carcinomas was felt unrelated to the presenting signs including diplopia, decreased vision, and positive visual phenomena. In several cases effects of treatment for the prostate carcinoma also produced symptoms including localized edema. Direct effect of the carcinoma was seen in 8 cases. Manifestations included cranial nerve palsies due to parasellar involvement, optic neuropathy due to orbital or intracranial compression, proptosis and restricted motility secondary to orbital roof and sphenoid wing involvement. The diagnosis could be made specifically by endoscopic biopsy and fine needle aspiration.

Conclusions: Although uncommon prostate metastatic disease is not a rare cause of pathology affecting the skull base. The advent of minimally invasive diagnostic techniques including endoscopic biopsy and fine needle aspiration biopsy may be helpful in making a specific diagnosis. These lesions may be responsive to radiation therapy.