Rare Multiple Brain Metastases Following Debulking Surgery and Androgen Deprivation Therapy in Aggressive Prostate Cancer - Case Report

Sep 23, 2026

Clinical practice shows most prostate cancer (PC) is localized and responds well, yet a subset behaves aggressively or develops resistance, causing metastasis and worse outcomes. Brain metastases are considered extremely rare, especially compared with the predominant bone involvement in advanced disease. This case report describes a patient who developed multiple brain metastases after prostate debulking surgery while maintaining androgen deprivation for four years. A sudden PSA rise triggered diagnosis and confirmed prostate origin. Comprehensive evaluation and multimodal treatment can reduce symptoms and improve survival.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

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Introduction

Case Report

Tech Science Press | Doi:10.32604/or.2025.066478
CASE REPORT |
| | --- | --- | | Rare Multiple Brain Metastases Following Debulking Surgery and Androgen Deprivation Therapy in Aggressive Prostate Cancer-Case Report
Andong Cheng1,2,\#, Yiding Chen1,\#, Hao Li1, Feixiang Yang1, Junlan Jiang3, Sheng Tai1, Weiwei Chen4, Yu Guan1, Shuiping Yin1, * and Jialin Meng1,2, *
1 Department of Urology, The First Affiliated Hospital of Anhui Medical University, Institute of Urology, and Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Anhui Medical University, Hefei, 230001, China
2 School of Life Sciences, Anhui Medical University, Hefei, 230032, China
3 Department of Pathology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230001, China 4 Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230001, China
*Corresponding Authors: [Shuiping Yin. Email: yinshuiping@ahmu.edu.cn](Shuiping Yin. Email: yinshuiping@ahmu.edu.cn); [Jialin Meng. Email: mengjialin@ahmu.edu.cn](Jialin Meng. Email: mengjialin@ahmu.edu.cn)
\# These authors contributed equally to this work.
Received: 09 April 2025; Accepted: 03 November 2025; Published: 19 January 2026
ABSTRACT: Background: In clinical practice, approximately 80% of prostate cancer (PC) cases are localized and can achieve favorable outcomes with appropriate treatment. Conversely, some remaining cases exhibit an aggressive phenotype or develop resistance to therapeutic interventions, leading to tumor metastasis and a poorer prognosis. When PC metastasizes to distant sites, the bone remains the predominant location, and brain metastases are regarded as exceedingly rare. Case Description: The current study focused on a rare clinical PC case that presented multiple brain metastases after prostate surgery. The patient was initially diagnosed with PC through prostate biopsy and subsequently underwent prostate debulking surgery while continuing androgen deprivation therapy, which maintained low prostatespecific antigen (PSA) levels for 4 years. However, a sudden PSA surge to 7.858 ng/mL led to the emergence of two brain metastatic tumors, which were confirmed to have originated from the prostate. Conclusions: Patients with advanced PC require comprehensive evaluations to detect rare metastatic sites, such as the brain, to avoid missed diagnoses. For patients with brain metastases, a multimodal approach combining surgical resection, postoperative radiotherapy, and endocrine therapy can effectively alleviate symptoms and enhance survival.
KEYWORDS: Prostate cancer; brain metastases; metastatic prostate cancer; castration-resistant prostate cancer; case report | | 1 Introduction Prostate cancer (PC) is the second most common malignancy in men worldwide. Approximately 80% of cases are localized to the prostate and can typically be effectively managed with surgery or endocrine therapy [1–3] . However, some cases may develop into castration-resistant PC (CRPC) or present distant metastases during treatment [4]. Distant metastases occur in most cases of advanced PC and are the leading cause of mortality in patients with PC [5] . Bone is the predominant site of distant metastasis in PC. Approximately 65%–75% of patients with advanced PC are diagnosed with bone metastases at initial diagnosis [6,7] . Hematogenous dissemination to the brain and central nervous system is uncommon[8,9] . PC cell invasion disrupts the osteoblastic-osteolytic Copyright © 2026 The Authors. Published by Tech Science Press. This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. balance, resulting in abnormal bone formation [10] . The brain microenvironment is a crucial determinant of brain metastasis progression. Brain-metastatic

FAQs

Why are brain metastases from prostate cancer considered rare?

Most distant spread in advanced prostate cancer involves bone, while hematogenous dissemination to the brain and CNS is uncommon. The low incidence and occult presentation also limit early detection.

What prompted the diagnosis of brain metastases in this case?

After four years of low PSA under androgen deprivation therapy, a sudden PSA surge to 7.858 ng/mL occurred, leading to identification of two brain metastatic tumors confirmed as originating from the prostate.

What treatment approach is recommended for patients with brain metastases from prostate cancer?

A multimodal strategy combining surgical resection, postoperative radiotherapy, and endocrine therapy can relieve symptoms and enhance survival.

Sep 23, 2026

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