Brain metastasis

[pca2004]

New (Portuguese) anecdotal case study below. [1]

When I began reading PCa studies on PubMed, I saw a lot of cell studies that used LNCaP (from a lymph PCa cell), PC3 (from a bone PCa cell) &/or DU145 (supposedly a brain met cell, but now described as "derived from a central nervous system metastasis") cells. I wondered what a DU145 study could tell me about PCa in general, brain mets being rare - & then I realized that the three cell types were not necessarily chosen because they mimicked actual human disease, but, rather, were chosen for their properties:

i) LNCaP: androgen-sensitive with low metastatic potential. Has androgen & estrogen receptors and express PSA. [2i]

ii) PC-3: androgen-insensitive with high metastatic potential. Does not express PSA. "PC3 is characteristic of small cell neoendocrine carcinoma". Most PCa bone mets are osteoblastic, but PC-3 is osteolytic. [2ii]

iii) DU145: androgen-sensitive. Does not express PSA. Moderate metastatic potential. [2iii]

Anyway, back to the new paper.

Brain mets are usually considered to be lethal within a year, but the man had a solitary met that was operable.

"The patient was treated with surgery, adjuvant irradiation of the surgical bed, and androgen deprivation therapy. He later underwent intensity-modulated radiation therapy (IMRT) to the prostate and has been remarkably relapse-free for four years."

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/375...

. 2023 Jul 17;15(7):e42022. doi: 10.7759/cureus.42022.eCollection 2023 Jul.

The Successful Treatment of a Case of Prostate Cancer With Brain Metastasis at Diagnosis

Ana Vasques Sr 1, Margarida Lagarto 1, Marta Pinto 2, Filipa Ferreira 3, Ana Martins 3

Affiliations

1 Medical Oncology, Hospital São Francisco Xavier, Lisbon, PRT.

2 Medical Oncology, Centro Hospitalar Tondela - Viseu, Viseu, PRT.

3 Medical Oncology, Centro Hospitalar de Lisboa Ocidental, Lisbon, PRT.

PMID: 37593296 PMCID: PMC10430886 DOI: 10.7759/cureus.42022

Abstract

Brain metastasis in prostate cancer is quite a rare entity, especially when it manifests at diagnosis. The symptoms are usually non-focal and vary based on the location affected. It is almost always associated with a poor prognosis, with an overall survival of less than a year. The ideal management modality for these patients is not well established but a combination of surgery, radiation, and chemotherapy may be possible options based on the extent and systemic involvement. Brain screening is not done systematically in prostate cancer and more research is needed to understand the outcome this decision would lead to. We report a case of a patient diagnosed with prostate cancer with single metastasis to the brain that manifested as headache and vomiting. The patient was treated with surgery, adjuvant irradiation of the surgical bed, and androgen deprivation therapy. He later underwent intensity-modulated radiation therapy (IMRT) to the prostate and has been remarkably relapse-free for four years.

Copyright © 2023, Vasques et al.

[2i] en.wikipedia.org/wiki/LNCaP

[2ii] en.wikipedia.org/wiki/PC3

[2iii] en.wikipedia.org/wiki/DU145

[PCaWarrior]

The cell types studied should be factored into our decision-making processes. You and I are primarily an LNCaP type phenotype.

Some therapies that are aimed at PC-3 or others, can cause LNCaP growth promotion.

What makes it very difficult is the heterogenous makeup. We might be 95% LNCaP types but we probably have some other lines as well. And then we have to think about how these change over time. I don't know how to get a definitive answer to specific makeup outside of a physical biopsy. Of course if we get one at T0, what will the blend be at T1 or T2?