Neurogenous Metastasis: Magnetic Resonance Imaging and Neurography in South African Men with Prostate Cancer

Objectives: Prostate cancer (PCa) is the most common malignancy in men, with variable presentation, clinical findings and natural progres-sion. The expanding field of cancer neurobiology has highlighted peri-neural invasion, perineural tumour spread, and malignant spinal cord compression as features of interest in PCa. This study explored the in-teraction between PCa and the peripheral and central nervous systems and whether prostate cancer interacts with the central via the periph-eral nervous system. Methods: Cross-sectional study. Adult men presenting with suspected PCa to a tertiary academic hos-pital in Pretoria were recruited. Patients with PCa confirmed via his-tology were subjected to magnetic resonance imaging or neurography, which was performed between February 2022 and October 2023. His-tological and radiological data were collected for descriptive and uni-variate analyses at the 5% significance level. Magnetic resonance neu-rography (MRN) of patients with biopsy-proven PCa, which is investi-gational for the indication of assessing direct nerve infiltration by PCa. Magnetic resonance imaging (MRI) of patients with clinical suspicion of spinal cord compression (SCC) which is standard of care regardless of the possible cause. Results: Main outcome measures- Radiological evidence of perineural tumour spread. Almost half (48.3%) of the 58 men enrolled had perineural invasion on histology. Perineural tumour spread on MRI was evident in 65.8% (n = 32) of the patients. Eight pa-tients presented with spinal cord compression caused by PCa in six pa-tients and disc herniation in two patients. Soft tissue and skeletal me-tastases were present in 51.2% and 34.5% of patients, respectively. Conclusion: MRI imaging demonstrates clear interaction of PCa with the nervous system. This neurogenous route of tumour dissemination represents a novel additional mechanism by which PCa may cause neurological complications in the regions supplied by the lumbosacral plexuses and spinal cord, including neuropathic pain. Future studies incorporating MRI with positron emission tomography/computed to-mography may better illustrate nerve involvement.