Post-laminectomy long-term survival of a patient with spinal cord compression secondary to metastatic prostate cancer

223 Background: Skeletal related events (SREs), defined as pathological fracture, spinal cord compression, surgery or radiotherapy to the bone, occur in nearly half of men diagnosed with metastatic prostate cancer. Accurate assessment of the risk of death associated with SREs is important to making decisions about the use of recently approved treatments, which have been shown to decrease the frequency of skeletal events, yet estimating the impact of SREs on survival presents several methodological challenges given the recurrent time-dependent nature of exposure. Methods: A cohort of men >65years of age, diagnosed with prostate cancer and bone metastasis between January 1, 2004 and December 31, 2009 was identified from the Surveillance Epidemiology and End Results (SEER) registries were linked to Medicare Parts A and B claims. The outcome of interest, death from any cause, was ascertained from SEER and survival time was calculated from the date of metastatic prostate cancer diagnosis. Multivariable Cox proportional hazards models treating the occurrence of an SRE as a time-dependent exposure were used to estimate the hazard ratios (HR) and corresponding 95% confidence intervals (CI) for the association between SRE occurrence, number, and type, and death. Results: Among 3,297 men with metastatic prostate cancer, 40% experienced ≥1 SRE during the observational follow-up period (median 19 months). Compared to men who remained SRE-free, cohort members who had ≥1 SREs had a two-fold higher risk of death (HR 2.2, 95% CI 2.0-2.4). Those whose first SRE was a pathological fracture had a 2.7-fold higher risk of death (HR 2.7, 95% CI 2.3-3.1), followed by spinal cord compression (HR 2.1, 95% CI 1.8-2.5), surgery (HR 1.8, 95% CI 1.5-2.2) and radiotherapy (HR 2.2, 95% CI 1.9-2.4). Compared to those experiencing only one SRE, men who experienced a second SRE of any type had double the risk of death (HR 2.2, 95% CI 1.9-2.6). Conclusions: SREs were associated with ≥50% reduction in overall survival. This finding is consistent across different types of SREs and supports using therapies to prevent or treat SREs in patients with prostate cancer metastatic to the bones.

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Can local treatment prolong the sensitivity of metastatic prostate cancer to androgen deprivation or even prevent castration resistance?

World Journal of Urology ◽

10.1007/s00345-020-03568-3 ◽

2021 ◽

Author(s):

Christina Niklas ◽

Matthias Saar ◽

Alessandro Nini ◽

Johannes Linxweiler ◽

Stefan Siemer ◽

...

Keyword(s):

Prostate Cancer ◽

Overall Survival ◽

Biochemical Recurrence ◽

Metastatic Prostate Cancer ◽

Locally Advanced ◽

Survival Rates ◽

Term Survival ◽

Long Term Survival ◽

Hormonal Manipulation

Abstract Purpose A number of observational clinical studies suggest that prior primary tumor treatment favorably influences the course of metastatic prostate cancer (PCa), but its mechanisms of action are still speculative. Here, we describe the long-lasting sensitivity to various forms of androgen deprivation in patients after radical prostatectomy (RP) for locally advanced PCa as one potential mechanism. Methods A consecutive series of 115 radical prostatectomies after inductive therapy for T4 prostate cancer was re-analyzed, and long-term survival, as well as recurrence patterns and responses to different forms of hormonal manipulation, were assessed. Results The estimated biochemical response-free, PCa-specific, and overall survival rates after 200 months were 20%, 65%, and 47% with a median overall survival of 156 months. The majority of patients, although not cured of locally advanced PCa (84/115), showed long-term survival after RP. PCa-specific and overall survival rates of these 84 patients with biochemical recurrence were 61% and 44% at 150 months. Long-term sensitivity to ADT was found to be the main reason for the favorable tumor-specific survival in spite of biochemical recurrence. Conclusions Sensitivity to primary or secondary hormonal manipulation was the main reason for the long-term survival of patients who had not been cured by surgery only. The results suggest that treatment of the primary tumor-bearing prostate delays castration-resistant PCa and enhances the effect of hormonal therapies in a previously unknown manner. The underlying cellular and molecular mechanisms need to be explored in more detailed analyses, which could profoundly impact treatment concepts of locally advanced and metastatic PCa.

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The Role of Surgical Management for Symptomatic Spinal Cord Compression in Patients with Metastatic Prostate Cancer

The Journal of Urology ◽

10.1016/s0022-5347(17)38750-5 ◽

1989 ◽

Vol 142 (2 Part 1) ◽

pp. 337-339 ◽

Cited By ~ 36

Author(s):

Daniel A. Shoskes ◽

Richard G. Perrin

Keyword(s):

Prostate Cancer ◽

Spinal Cord ◽

Surgical Management ◽

Spinal Cord Compression ◽

Metastatic Prostate Cancer ◽

Cord Compression

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Unexpected long-term survival in an adult patient with metastatic prostate cancer

Urology Case Reports ◽

10.1016/j.eucr.2021.101634 ◽

2021 ◽

Vol 37 ◽

pp. 101634

Author(s):

P. Antonov ◽

G. Raycheva ◽

V. Popov

Keyword(s):

Prostate Cancer ◽

Adult Patient ◽

Metastatic Prostate Cancer ◽

Term Survival ◽

Long Term Survival

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Metastatic prostate cancer and spinal cord compression

Challenging Concepts in Oncology ◽

10.1093/med/9780199688883.003.0014 ◽

2015 ◽

pp. 155-164

Author(s):

Helen O’Donnell ◽

Indrani Bhattacharya

Keyword(s):

Prostate Cancer ◽

Spinal Cord ◽

Spinal Cord Compression ◽

Metastatic Prostate Cancer ◽

Cord Compression

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Spinal Cord Compression in Metastatic Prostate Cancer

European Urology ◽

10.1016/s0302-2838(03)00355-5 ◽

2003 ◽

Vol 44 (5) ◽

pp. 527-532 ◽

Cited By ~ 28

Author(s):

H. Tazi ◽

A. Manunta ◽

A. Rodriguez ◽

J.J. Patard ◽

B. Lobel ◽

...

Keyword(s):

Prostate Cancer ◽

Spinal Cord ◽

Spinal Cord Compression ◽

Metastatic Prostate Cancer ◽

Cord Compression

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Models predicting survival to guide treatment decision-making in newly diagnosed primary non-metastatic prostate cancer: a systematic review

BMJ Open ◽

10.1136/bmjopen-2019-029149 ◽

2019 ◽

Vol 9 (6) ◽

pp. e029149 ◽

Cited By ~ 3

Author(s):

David Thurtle ◽

Sabrina H Rossi ◽

Brendan Berry ◽

Paul Pharoah ◽

Vincent J Gnanapragasam

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Metastatic Prostate Cancer ◽

Data Extraction ◽

Risk Of Bias ◽

Prognostic Models ◽

Cochrane Library ◽

Term Survival ◽

Long Term Survival

ObjectivesMen diagnosed with non-metastatic prostate cancer require standardised and robust long-term prognostic information to help them decide on management. Most currently-used tools use short-term and surrogate outcomes. We explored the evidence base in the literature on available pre-treatment, prognostic models built around long-term survival and assess the accuracy, generalisability and clinical availability of these models.DesignSystematic literature review, pre-specified and registered on PROSPERO (CRD42018086394).Data sourcesMEDLINE, Embase and The Cochrane Library were searched from January 2000 through February 2018, using previously-tested search terms.Eligibility criteriaInclusion required a multivariable model prognostic model for non-metastatic prostate cancer, using long-term survival data (defined as ≥5 years), which was not treatment-specific and usable at the point of diagnosis.Data extraction and synthesisTitle, abstract and full-text screening were sequentially performed by three reviewers. Data extraction was performed for items in the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies checklist. Individual studies were assessed using the new Prediction model Risk Of Bias ASsessment Tool.ResultsDatabase searches yielded 6581 studies after deduplication. Twelve studies were included in the final review. Nine were model development studies using data from over 231 888 men. However, only six of the nine studies included any conservatively managed cases and only three of the nine included treatment as a predictor variable. Every included study had at least one parameter for which there was high risk of bias, with failure to report accuracy, and inadequate reporting of missing data common failings. Three external validation studies were included, reporting two available models: The University of California San Francisco (UCSF) Cancer of the Prostate Risk Assessment score and the Cambridge Prognostic Groups. Neither included treatment effect, and both had potential flaws in design, but represent the most robust and usable prognostic models currently available.ConclusionFew long-term prognostic models exist to inform decision-making at diagnosis of non-metastatic prostate cancer. Improved models are required to inform management and avoid undertreatment and overtreatment of non-metastatic prostate cancer.

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