The growth of
prostate cancer is controlled by several
hormones and
growth factors. In cases of metastasized
prostate cancer, antigonadotropic
therapy is currently considered state-of-the-art treatment. Surgical
therapies such as
adrenalectomy and
hypophysectomy are no longer in use. Nevertheless,
hypophysectomy has proven efficacy for palliative
pain treatment as well as increasing duration of survival. The authors present the case of a 63-year-old man with metastatic
prostate cancer who presented with high serum
prostate-specific antigen levels (1216 microg/L) and
cavernous sinus syndrome. His disease was progressing despite
leuprorelin and
docetaxel therapy, and he had severe bone
pain despite high-dose
pain therapy. He was also anemic. Contrast-enhanced MR imaging showed a pituitary lesion as well as metastatic infiltration of the skull base including the cavernous sinus. The patient's serum level of
prolactin was mildly elevated,
testosterone was below the detection limit, and
insulin-like growth factor-I (
IGF-I) was in the upper range for a patient of his age (233 microg/L). Because of the elevated
prolactin and high-normal
IGF-I levels he was offered a
hypophysectomy in addition to
pituitary tumor removal. Histological examination of the resected lesion confirmed a nonsecreting
pituitary adenoma with infiltration of
prostate cancer cells. Postoperatively the patient's
prostate-specific antigen levels dropped to 876 microg/L, his bone
pain resolved, and the
cavernous sinus syndrome improved. Nevertheless, he died of
septicemia 4 months after surgery. Older publications as well as this case have shown the benefit of
hypophysectomy for
pain treatment. A reduction of
IGF-I levels even in the final stage metastasized
prostate cancer may play a major role. Respectively, clinical studies with
somatostatin analogs are currently in progress, which may lead to a "new" way of treatment in these otherwise hopeless patients. On the basis of the
pain relief seen after
hypophysectomy in this case and similar benefits reported in older publications, the authors raise the question whether this treatment should be offered more frequently, and whether additional medical options of
hormone treatment may be beneficial in similar cases.