BACKGROUND: Metastatic spinal cord compression from prostate cancer is a debilitating disease causing neurological deficits, mechanical instability, and intractable pain.
Surgical management may improve quality of life.
OBJECTIVE: To define postoperative outcomes and explore associations with prolonged survival for patients with metastatic prostate cancer.
METHODS: Retrospective chart reviews were performed of all patients undergoing spinal surgery for metastatic cancer from June 1, 2002 to August 31, 2011. Patient demographics, surgical details, adjuvant therapies, outcomes, complications, and postoperative survival were reviewed.
RESULTS: Twenty-seven prostate cancer patients underwent surgery at a median age of 65 years (range 46-82 years). After surgery, 93% of patients had preserved or improved neurological status, 56% of non-ambulatory patients recovered ambulation, 43% of incontinent patients recovered continence, and 23% experienced complications. Postoperative Frankel grades were significantly improved by at least one letter grade at 1 month (p= .03). The median analgesic and steroid usage was significantly lower up to 3 months and 6 months postoperative, respectively (p= .007, .005). Median survival following surgery was 10.2 months, and patients with castration-resistant prostate cancer had a shorter median survival than those with hormone-naïve disease (9.8 vs. 40 months). Better preoperative performance status was an independent predictor of survival (p= .02). Younger age (p= .005) and instrumentation greater than seven spinal levels (p= .03) were associated with complications.
CONCLUSION: Spinal surgery for prostate metastases improves neurological function and decreases analgesic requirements. Our findings support surgical intervention for carefully selected patients, and knowledge of preoperative hormone sensitivity and performance status may help with risk stratification.
Written by:
Ju DG, Zadnik PL, Groves ML, Hwang L, Kaloostian PE, Wolinksy JP, Witham TF, Bydon A, Gokaslan ZL, Sciubba DM. Are you the author?
Department of Neurosurgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Reference: Neurosurgery. 2013 Jul 8. Epub ahead of print.
doi: 10.1227/NEU.0000000000000070
PubMed Abstract
PMID: 23839521
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