METASTATIC PROSTATE-CANCER TO THE OPTIC CANAL

Purpose: Optic neuropathies represent a common cause of blindness amon g patients with cancer. The authors present the clinical and imaging f indings and discuss the management of optic nerve involvement from met astatic prostate cancer to the optic canal. Methods: Five patients wit h advanced metastatic prostate cancer had visual loss. Neurophthalmolo gic examination and pre- and post-gadolinium orbital and brain magneti c resonance imaging (MRI) were performed. Compressive optic neuropathy secondary to extensive optic canal involvement was demonstrated in al l of the patients. Neuropathologic examination was acoomplished in two cases. A combination of steroid and focal radiation therapy was used for treatment in four patients. Results: Imaging and neuropathologic f indings demonstrated a compressive optic neuropathy secondary to both epidural metastases and to deformity and hypertrophy of the optic cana l due to metastatic cancer. Treatment was of benefit in three cases. C onclusion: Acute and subacute unilateral or bilateral optic neuropathy in patients with prostate cancer may be the result of optic canal met astases. Magnetic resonance imaging shows a characteristic pattern of bone hypertrophy and deformity with optic nerve compression. Early com bination steroid and radiation therapy may induce long-lasting improve ment.