Background:
Dermal involvement from metastatic prostate cancer is a rare manifestation of a commonly diagnosed malignancy (1). Distribution of these cutaneous metastases mostly occurs in the suprapubic region and less so in the head and neck (2) – (3), and can cause symptoms such as pain and bleeding. Evidence on management of these lesions with radiotherapy is scarce (4) – (6). This case report highlights a patient with distant cutaneous metastasis of prostate cancer on his scalp, who achieved clinically durable response when managed with palliative radiotherapy.
Case Presentation:
An 84-year-old multimorbid gentleman with metastatic castrate-resistant prostate cancer was referred for palliative radiotherapy for bleeding and painful frontal and parietal scalp cutaneous metastasis. This patient was initially diagnosed with de-novo metastatic castrate-sensitive prostate adenocarcinoma, with development of multiple biopsy-proven skin metastasis across his face and back 7 months later. These were initially excised by his GP for palliative intent, but the growth in size and number of lesions, especially across his scalp, made it surgically inoperable under local anesthetic.
Treatment:
The patient received a total of 18Gy in 3 fractions at 6Gy per fraction, delivered daily to the frontal and parietal scalp in 6 MeV electron beams with bolus. The patient tolerated radiotherapy without any toxicity or complications. At follow-up 3 months after treatment, there was good clinical effect to the lesions, with noticeable reduction in the size, cessation of bleeding and improvement of pain.
Discussion:
Cutaneous metastasis from prostate cancer often indicates late-stage disease with poor prognosis (1). Therapeutic options are variable due to the rarity of its incidence. Radiotherapy for cutaneous metastasis from prostate cancer is a safe and viable treatment option to achieve durable clinical response. Our experience shows that a hypofractionated regime is effective, in the context of the low α/β ratio of prostate cancer (7).