Rapid Development of Spinal Epidural Lipomatosis after Treatment of Metastatic Castration-resistant Prostate Cancer with Second-Generation Androgen Receptor Antagonists.

Rapid Development of Spinal Epidural Lipomatosis after Treatment of Metastatic Castration-resistant Prostate Cancer with Second-Generation Androgen Receptor Antagonists.

World Neurosurg. 2019 Feb 11;:

Authors: Mattei TA, Goulart CR, Rai SS, Rehman AA, Williams M, Mendel E

Abstract
BACKGROUND: Previous studies have described the association of spinal epidural lipomatosis with several conditions including chronic steroid therapy, Cushing's syndrome, obesity, Paget's disease, and hypothyroidism. We present a report of rapid development of spinal epidural lipomatosis after treatment with second-generation anti-androgen therapy, a new strategy for treatment of metastatic castration-resistant prostate cancer which has been increasingly employed in the past few years. A comprehensive discussion of the underlying molecular networks involving androgen receptor blockage and adipocyte differentiation as well as the clinical implications of such a phenomenon is provided.
CASE DESCRIPTION: We describe the clinical and radiological evolution of a 58 year-old male patient with metastatic prostate cancer who developed new onset of rapidly progressing lumbosacral epidural lipomatosis with significant compression of the nerve roots of the cauda equina a few months after initiation of treatment with second-generation androgen receptor antagonists CONCLUSIONS: The underlying pathophysiology of adipose tissue growth following the administration of anti-androgen therapy is discussed, with particular emphasis on both the canonical Wnt/β-catenin pathway as well as in the Wnt-independent pathway involving direct activation of downstream T-cell factor (TCF) family transcription factors by the androgen receptor. As second-generation androgen receptor antagonists have been increasingly utilized for treatment of castration-resistant stage metastatic prostate cancer, new onset of symptomatic epidural lipomatosis should be considered as a possible therapeutic complication of such drugs, especially since the urinary symptoms of cauda equina compression may be improperly attributed to the primary prostate neoplasm.

PMID: 30763756 [PubMed - as supplied by publisher]

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