Extra-axial small cell prostate carcinoma intracranial metastasis: illustrative case.

backgroundProstate carcinoma, despite being the most common cancer in men, rarely metastasizes to the brain. Small cell prostate carcinoma represents a small percentage of cases, and few cases of intracranial small cell prostate metastases have been reported. Here, the authors report a unique case of an operatively managed extra-axial small cell prostate carcinoma. OBSERVATIONS: A 63-year-old male with a history of small cell prostate carcinoma presented asymptomatically with abnormal brain imaging. MRI and prostate-specific membrane antigen PET imaging revealed a 2.8-cm mass in the right frontal lobe and a smaller right thalamic lesion. The mass was resected through a frontotemporal approach, and gross-total resection was achieved. The patient will receive adjuvant chemotherapy and radiation therapy. LESSONS: Intracranial prostate metastases tend to be slow growing and can have indolent clinical courses, although they can become symptomatic at large sizes. Small cell prostate metastases are more aggressive than adenocarcinoma and have a higher propensity for dural rather than intraparenchymal localization. The standard of care, which is derived from the management of metastatic prostate adenocarcinoma, involves maximal safe resection and adjuvant chemotherapy and radiation therapy, although intracranial small cell prostate metastases are a poor prognosticator. https://thejns.org/doi/10.3171/CASE24705.