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Clinical and Genetic Analysis of Metastatic Prostate Cancer to the Central Nervous System: A Single-Institution Retrospective Experience

  • Author Footnotes
    # A.J. and E.B.J. contributed equally to this work.
    Albert Jang
    Footnotes
    # A.J. and E.B.J. contributed equally to this work.
    Affiliations
    Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA
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  • Author Footnotes
    # A.J. and E.B.J. contributed equally to this work.
    Ellen B. Jaeger
    Footnotes
    # A.J. and E.B.J. contributed equally to this work.
    Affiliations
    Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA
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  • Elisa M. Ledet
    Affiliations
    Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA
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  • John Xie
    Affiliations
    Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA
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  • Brian E. Lewis
    Affiliations
    Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA
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  • Jodi L. Layton
    Affiliations
    Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA
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  • Oliver Sartor
    Affiliations
    Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA
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  • Pedro C. Barata
    Affiliations
    Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA
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  • Christopher R. Trevino
    Correspondence
    Address for correspondence: Christopher R. Trevino, Tulane Cancer Center, Deming Department of Medicine, Section of Hematology and Medical Oncology, 1430 Tulane Ave #8078, New Orleans, LA 70112
    Affiliations
    Section of Hematology and Medical Oncology, Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA
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  • Author Footnotes
    # A.J. and E.B.J. contributed equally to this work.
Published:October 20, 2022DOI:https://doi.org/10.1016/j.clgc.2022.10.007

      Abstract

      Background

      Prostate cancer (PC) rarely metastasizes to the central nervous system (CNS). In this retrospective single-institution study at a tertiary cancer center, we aimed to evaluate the clinical and genetic characteristics of advanced PC patients with CNS metastases.

      Patients and Methods

      Between January 2010 and March 2020, 12 out of 579 patients with extracranial metastatic PC were identified to have CNS metastases based on imaging, including six patients with brain metastases (BMs), five patients with dural metastases, and one unknown. These patients were followed up through March 2022. Clinical data were compared to the overall cohort of patients evaluated at our cancer center during that decade. Genetics information was also analyzed for the patients with available data via cell-free DNA (cfDNA) blood samples.

      Results

      Median time from development of extracranial metastatic disease to development of CNS metastases was 5.5 years (95% CI, 1.8-7.0). Median overall survival (mOS) from diagnosis of CNS metastases was 6.1 months (95% CI, 5.8-8.2). Notably, there was no significant difference in mOS after development of extracranial metastases in patients with CNS metastases (6.4 years; 95% CI, 4.6-7.9) compared to the patients without known CNS metastases (5.2 years; 95% CI, 4.6-5.7) (P = .91). For the cohort with CNS metastases, nine patients had germline testing and seven patients had somatic testing via cfDNA.

      Conclusion

      PC patients with CNS metastases did not often die from a neurological cause. With advancing therapies, the overall prognosis of metastatic PC continues to improve, and CNS metastases will become more common.

      Keywords

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