Urological Cancer Metastasis to the Brain: When Should We Resect?

ABSTRACT

Introduction: Although metastasis from urological malignancies to the brain occur late in the disease process and are typically associated with a poor prognosis, prolonged survival and excellent quality of life is achievable in a small, select population of patients. Surgical management has historically been utilized with large brain metastases, resulting in rapid increases in intracranial pressure and/or severe neurological deficits; however, the indications for surgical resection in the nonemergent setting are less clear.

Methods: The National Library of Medicine search engine PubMed was used to search for terms, including “brain metastasis, renal cell carcinoma,” “brain metastasis, bladder cancer,” “brain metastasis, prostate cancer,” and “brain metastasis, nonseminomatous testicular germ cell tumors.”

Results: Patients with renal cell carcinoma who typically have well circumscribed, firm radio and chemoresistant brain metastasis and patients with nonseminomatous testicular germ cell tumors who are generally younger with synchronous brain metastasis should be considered for aggressive surgical resection. Patients with brain metastasis from bladder or prostate cancer have a poor overall prognosis, and surgical resection is typically used only to improve quality of life, if not marginally extend survival.

Conclusion: Brain metastasis from urologic cancers are a late disease manifestation and surgical therapy is reserved for patients with a good Karnofsky Performance Status (> 70), minimal-to-no systemic disease, solitary large lesions (preferably > 3 cm), and those with a life expectancy of more than 3 months.

Zachary Klaassen, Faris Shweikeh, Ronald S Chamberlain

Date Received: January 26, 2012 Accepted on: February 22, 2012

KEYWORDS: brain metastasis, renal cell carcinoma, bladder cancer, prostate cancer, nonseminomatous testicular germ cell tumors

CORRESPONDENCE: Ronald S. Chamberlain, Chairman and Surgeon-in-Chief, MD, MPA, FACS, Saint Barnabas Medical Center, Livingston, New Jersey, 07039 United States (rchamberlain@sbhcs.com).

CITATION: UroToday Int J. 2012 Apr;5(2):art 10. http://dx.doi.org/10.3834/uij.1944-5784.2012.04.10