Clinical outcome of surgical management for symptomatic metastatic spinal cord compression from prostate cancer
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RESEARCH ARTICLE
Open Access
Clinical outcome of surgical management for symptomatic metastatic spinal cord compression from prostate cancer Yasuhide Miyoshi1* , Takashi Kawahara1, Masahiro Yao2 and Hiroji Uemura1
Abstract Background: Metastatic spinal cord compression (MSCC) from prostate cancer (PC) influences not only patients’ prognosis but also their quality of life. However, little is known about the clinical outcome of surgery for MSCC from PC. We evaluated both the oncological and functional outcomes of decompression and reconstruction surgery for patients with symptomatic MSCC from PC. Methods: We assessed 19 patients who underwent decompression and reconstruction surgery for symptomatic MSCC from PC. Of these 19 patients, 8 had metastatic hormone-naïve PC (mHNPC) and 11 had metastatic castration-resistant PC (mCRPC). Results: The median age of the patients with mHNPC and mCRPC was 72 and 65 years, respectively. The median prostate-specific antigen level at the time of diagnosis of MSCC in patients with mHNPC and mCRPC was 910 and 67 ng/mL, respectively. Although two of eight patients (25.0%) with mHNPC were ambulatory preoperatively, six patients (75.0%) were ambulatory postoperatively. Among 11 patients with mCRPC, only 3 (27.3%) were ambulatory preoperatively, while 6 (54.5%) were ambulatory postoperatively. The median postoperative overall survival among patients with mHNPC and mCRPC were not reached and 8 months, respectively. Conclusions: Decompression and reconstruction surgery for symptomatic MSCC from PC might contribute to a favorable functional outcome among men with mHNPC and mCRPC. However, its role in improving the oncological outcome remains unclear. The treatment strategy should be chosen by shared decision-making among patients, urologists, radiation oncologists, and orthopedic surgeons. Keywords: Prostate cancer, Castration-resistant prostate cancer, Spinal cord compression, Bone metastas
Background The incidence of prostate cancer (PC) has increased worldwide [1]. Although prostate-specific antigen screening has contributed to improvement in PC-related mortality [2], PC remains a leading cause of mortality and morbidity worldwide [1]. Metastatic hormone-naïve PC (mHNPC) is androgen-dependent, and androgen ablation * Correspondence: [email protected] 1 Department of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 2320024, Japan Full list of author information is available at the end of the article
therapy is initially effective; however, most patients with mHNPC become resistant to androgen ablation therapy and failed to metastatic castration-resistant PC (mCRPC) [3]. Osseous metastases are common in both patients with mHNPC and mCRPC [4, 5] and impair patients’ quality of life because of skeletal-related events. Approximately onethird of PC metastases to the spine become symptomatic, resulting in metastatic spinal cord compression (MSCC) [6] or mechanical instability [7] . MSCC occurs in 5% of p
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