Abstract
Introduction:
Prostate cancer is the third most common cancer in Indian men. Metastasis from prostate cancer commonly occurs through the Batson’s venous plexus to the spine, lymph nodes, lungs and liver. Metastases to the skull is rare. The base of the skull, particularly the clivus, is the most affected area with the clinical features depending on the size and location of the lesion, and compression of the surrounding structures.
Case:
A 66-year-old male presented with complaints of persistent headache and double vision for 3 months; hearing loss for 2 months; and symptoms of bladder outlet obstruction for 1 week. He was primarily investigated by an Ophthalmologist for double vision and glaucoma control but when there was no improvement after 1 month, so he was referred to a neurophysician who diagnosed right abducens nerve and vestibulocochlear nerve palsy. Taking into consideration the patient’s urinary complaints we suspected prostate pathology and the patient was diagnosed with moderately differentiated adenocarcinoma of the prostate with metastasis at clivus, skull vault and skull base. He was referred to the Urology department and bilateral orchiectomy was done. On follow-up the PSA levels had dropped, and his diplopia and hearing had improved.
Discussion:
The key to successful management in such patients is early diagnosis, correct localization of cranial nerve lesion and histopathological diagnosis of cancer staging. In our case, detailed labs for etiology of cranial nerve palsy led to the early diagnosis of prostate cancer. In cases where solitary or multiple cranial nerves are involved and a clival lesion is suspected, a prostate pathology should be suspected and per rectal examination. PSA and prostate biopsy should be done. This case is unique as the patient was treated with orchidectomy rather than radiotherapy or brain surgery. Early detection of prostate cancer helps in improving prognosis of disease, however metastatic prostate carcinoma is still associated with high morbidity and mortality.
