Metastatic Prostate Cancer of the Skull Base and Paranasal Sinuses

Introduction: Primary cancers of the paranasal sinuses are more common than metastatic disease. Metastatic carcinoma of the prostate to the sinonasal tract is rare. Prostate cancer metastasis to the skull base is frequently associated with hormone resistant disease.

Description of Case: Three cases were identified from personal teaching files of patients with metastatic prostate cancer to the skull base/paranasal sinuses. All three patients had known prostate cancer with bone metastases and were undergoing treatment. Mean age of patients was 64.3 years. All patients presented with sudden onset change in vision, with two of the three patients displaying abducens nerve palsy on physical exam. All patients were initially diagnosed as having sinusitis prior to imaging. CT and/or MRI confirmed sinus disease and mass lesion extending either intracranially or into skull base. One patient had severe sinusitis with associated orbital cellulitis. Biopsy performed in all 3 patients revealed metastatic prostate cancer. 2 patients were treated with radiation, and the third patient died prior to initiation of radiation.

Discussion: Although prostate cancer metastasis to the skull base and paranasal sinuses has been described, sinusitis associated with metastatic prostate cancer has not. Complicated sinusitis may also present with cranial neuropathies, however, it is important to consider metastasis as the etiology. Cranial neuropathies from metastatic disease portend a poor prognosis. In older male patients that do not respond to typical sinus treatment, a neoplastic process should be considered.