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Metastasis of Prostate Cancer to the Optic Canal

• PCa is the second most common diagnosed cancers (14%) and the second leading cause of cancer death in United States males, with average lifetime risk of 12.5% (1 in 8) and a mortality rate of 0.189% (18.9 in 100,000)^1,2
• With an emphasis on early detection, only a small percentage of PCa present with distant disease^1,2
• Ocular Metastases occur in 1-4.7% of metastatic cancer patients. A rate that is change with improving chemotherapy³
• Here, we review cases of PCa with an optic canal metastasis

• Retrospective literature review and pooled analysis
• Sub-group analysis of the initial presentation (IP) cases and the after diagnosis (AD) cases

• Ocular metastases are high-unusual, but can be the initially presentation for PCa the involvement of other structures, such as the axial skeleton (e.g. pelvis and spine)
• Symptoms such as diplopia and proptosis were more common for an initial presentation, whereas visual acuity and vision loss were not significantly different between groups

• We identified 45 case of published reports of patients with prostate cancer with metastasis to the optic canal, including one from our institution
• 20 cases (44%) presented with ocular metastasis in the initial presentation
• The average age of cases is 66.8-years-old which coincides with the national median age of 67-years-old
• Thirteen cases (29%) involved with additional ocular metastases to either the optic nerve, optic disc, choroid, or orbit
• Thirty-two cases reported mortality data, with sixteen reporting patient death after diagnosis (50%)
• One case (2.2%) involved solitary lesions to the optic nerves bilaterally and only
• Thirty-seven cases reported primary adenocarcinoma on histology (95%)

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Methods

Discussion

Conclusion

Neil Kelkar BS¹, Jue Wang MD, FACP^2,3,4

Introduction: Metastatic Prostate Cancer (PCa)

¹ University of Arizona College of Medicine– Phoenix, Phoenix, Arizona, USA

² Creighton University School of Medicine, Phoenix, Arizona, USA

³ St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA

⁴ Dignity Health Cancer Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA

Results

Figure

1. Key Statistics for Prostate Cancer | Prostate Cancer Facts [Internet]. [cited 2022 Apr 29]. Available from: https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html

2. Cancer of the Prostate - Cancer Stat Facts [Internet]. SEER. [cited 2022 Apr 29]. Available from: https://seer.cancer.gov/statfacts/html/prost.html

3. Cohen VML. Ocular metastases. Eye (Lond). 2013 Feb;27(2):137–41.

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• Ocular metastases are probably underdiagnosed and underlying molecular events are poorly understood
• Because early diagnosis and prompt management may positively alter the prognosis for these patients, ophthalmologists should be aware of this entity
• With advances in systemic treatments  and local modalities, tumor control and vision preservation can be increasingly efficient
• The combination of systemic and local treatments is complex and highly dependent on the presentation of the ocular metastasis and patient‘s prognosis 
• Before large evidence-based studies are available, the role of multidisciplinary team involvement should be emphasized

References

Tables

Figure 1: Gleason Score Breakdown Between Subsets

Table 2: Breakdown of Reported Symptoms of Published Cases of Metastatic Prostate with Optic Canal Involvement

Table 1: Breakdown of Clinical Characteristics

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