Abstract
BACKGROUND: Brain metastases (BrM) from prostate cancer (PC) are rare. This study sought to evaluate their prevalence, clinical features, treatment modalities, and survival outcomes. METHODS: From a database of BrM patients, we analyzed 28 cases of prostate cancer treated at our center between 2008 and 2023. RESULTS: BrM from PC comprised 0.7% of cases. The majority of patients had high-risk features at PC diagnosis: median prostate-specific antigen (PSA) at diagnosis was 65.5 ng/ml (range: 3.9-784.7 ng/ml), 82% were Gleason grade group ≥ 4, and 68% had perineural invasion (PNI). At BrM diagnosis, 79% were castrate-resistant. Most patients had concurrent metastases, including bone (94%), lymph nodes (63%), or lung (6%). Fifty percent presented with a single brain lesion, and the median Graded Prognostic Assessment (GPA) score was 1.5 (range: 0.5-2.5). Patients commonly had radiographic brain edema (57%) and neurological symptoms (54%), whereas only 7% had seizures. Median overall survival (OS) was 9.4 months (95% CI: 4.8-14.8 months) after BrM diagnosis. An upward trend in OS was observed with higher GPA (P = .07). Treatment modalities, including surgery with adjuvant radiation, stereotactic radiosurgery, and whole brain radiotherapy, showed no significant difference in median OS (9.4, 10.1, and 11.0 months respectively, P = .79). OS did not significantly differ between patients with a single versus multiple BrM or patients with castrate-sensitive versus castrate-resistant PC. CONCLUSION: BrMs from prostate cancer are rare and predominantly occur in patients with advanced, castrate-resistant disease, often accompanied by other metastases. This analysis enhances our understanding of the disease trajectory and informs treatment discussions.