Outcomes after surgery for spinal cord compression among men with metastatic prostate cancer

Spinal cord compression is a relatively common consequence of advanced, metastatic prostate cancer. Treatment has historically involved reconstructive surgery to relieve the compression and stabilize the spine.

In a new paper by Crnalic et al., the authors suggest that criteria for selecting patients with metastatic prostate cancer who may benefit from surgical treatment to relieve spinal cord compression have not been well defined.

Crnalic et al. carried out a retrospective review of the records of 54 consecutive patients with metastatic prostate cancer who were treated surgically for spinal cord compression at Umeå University Hospital in Sweden. The indication for surgery was “neurological deficit due to spinal cord compression,” meaning that that the patient had significant functional problems (up to and including the inability to walk).

Their key study results are as follows:

  • 41/54 patients (76 percent) had hormone-refractory prostate cancer.
  • 13/54 patients had previously untreated, hormone-naïve prostate cancer.
  • 29 patients received posterior spinal decompression only.
  • 25 patients received posterior spinal decompression and stabilization.
  • Prior to their surgery 48/54 patients (89 percent) were unable to walk.
  • At just 1 month after surgery
    • 33/54 patients (61 percent) were walking.
    • 15/54 patients (28 percent) were still unable to walk.
    • 6/54 patients (11 percent) had died.
  • Mortality rates post-surgery were
    • 11 percent at 1 month
    • 41 percent at 6 months
    • 59 percent at 1 year
  • 8/13 patients who were hormone-naïve at diagnosis (62 percent) were still alive with a median postoperative follow-up of 26 months.
  • The average (median) survival of the patients who were hormone refractory was just 5 months.
  • The survival of patients with hormone-refractory disease was directly related to their Karnofsky performance status (KPS) at the time of surgery.
    • Men with a KPS of ≤ 60 percent had median survival of 2.5 months.
    • Men with a KPS of 70 percent had a median survival of 7 months.
    • Men with a KPS of ≥ 80 percent had a median survival of 18 months.
  • Visceral metastases were present in 12/41 patients with hormone-refractory tumor at the time of spinal surgery.
  • Men with hormone-refractory disease and visceral metastases at time of surgery had a median survival of 4 months (as compared to a median survival of 10 months in patients with no visceral metastases).
  • Complications within 30 days of surgery were observed in 19/54 patients.

The authors conclude that patients with hormone-naïve, metastatic prostate cancer and patients with hormone-refractory, metastatic prostate cancer who also have good performance status and no evidence of visceral metastases may be helped by surgical intervention for spinal cord compression.

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