Characterization of metastatic spinal cord compression from prostate cancer.

248 Background: Spinal cord compression (SCC) is one of the most debilitating conditions in metastatic prostate cancer patients (pts). A comprehensive analysis of pts could shed lights on predisposing factors and help with devising new ways for early detection and prompt treatment. Methods: 52 pts with magnetic resonance imaging-confirmed metastatic SCC from prostate cancer were identified at MD Anderson Cancer Center. Characteristics including age, anatomical site, Gleason score, overall survival(OS), time to diagnosis of SCC, underlying gene mutations, numbers of bone metastasis, number of lines of treatment and clinical outcome were analyzed. Results: 96.15% of SCC occurred in thoracic spine in comparison to 74% as reported previously. At the time of diagnosis of SCC, median age is 70 years, median OS is 1537 days, median time to development of SCC is 1222.5 days, median lines of systemic treatment is 4, median PSA value is 66.4, 100% of pts have a Gleason score above 7, 94% of pts have >4 bone metastasis, roughly 20% of pts had visceral metastases. 55% of 9 evaluable pts harbored P53 gene mutation. About 80% of pts received radiation treatment; 17% of pts received surgery; 49% of pts had fair clinical outcome after treatment (Table). Conclusions: The observed predominance of SCC in thoracic spine (96.15%) suggests an underlying mechanism governing development of SCC in preferential sites. Further research to define this mechanism will help with prevention, detection and treatment of SCC. Additionally, characterized potential predictive factors (Gleason score≥7, >4 bone mets, presence of P53 mutation) could be used to develop an algorithm to improve the management of SCC.[Table: see text]

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Clinical outcome of surgical management for symptomatic metastatic spinal cord compression from prostate cancer

10.21203/rs.2.14520/v1 ◽

2019 ◽

Author(s):

Yasuhide Miyoshi ◽

Takashi Kawahara ◽

Masahiro Yao ◽

Hiroji Uemura

Keyword(s):

Prostate Cancer ◽

Spinal Cord ◽

Clinical Outcome ◽

Functional Outcome ◽

Spinal Cord Compression ◽

Specific Antigen ◽

Oncological Outcome ◽

Cord Compression ◽

Castration Resistant Prostate Cancer ◽

Reconstruction Surgery

Abstract BackgroundMetastatic spinal cord compression (MSCC) from prostate cancer (PC) influence to not only prognosis but also quality of life of patients. However little were known about clinical outcome of surgery for MSCC from PC. We evaluated both oncological and functional outcome of decompression and reconstruction surgery for patients with symptomatic MSCC from PC. MethodsWe assessed 19 patients who were performed decompression and reconstruction surgery for symptomatic MSCC from PC. Those of 19 patients, 8 were patients with metastatic hormone naïve prostate cancer (mHNPC) and 11 were patients with metastatic castration-resistant prostate cancer (mCRPC). ResultsMedian age of MSCC of patients with mHNPC and mCRPC were 72 and 65, respectively. Median prostate-specific antigen (PSA) levels at diagnosed as MSCC of patients with mHNPC and mCRPC were 910 ng/mL and 67 ng/mL, respectively. Although 2 out of 8 patients (25.0 %) with mHNPC were ambulatory preoperatively, 6 patients (75.0 %) were ambulatory postoperatively. Among 11 patients with mCRPC, only 3 patients (27.3 %) were ambulatory preoperatively, 6 patients (54.5 %) were ambulatory postoperatively. Median postoperative overall survival among men with mHNPC and mCPRC were not reached and 8 months, respectively. ConclusionsOur current study demonstrated that decompression and reconstruction surgery for symptomatic MSCC form PC might contribute favorable functional outcome among men with mHNCP and mCRPC. However, its role for improving the oncological outcome remains unclear. Anyway, treatment strategy should be made by shared-decision making among patients, urologists, radiation oncologists, and orthopedic surgeons.

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Clinical outcome of surgical management for symptomatic metastatic spinal cord compression form prostate cancer.

10.21203/rs.2.14520/v2 ◽

2020 ◽

Author(s):

Yasuhide Miyoshi ◽

Takashi Kawahara ◽

Masahiro Yao ◽

Hiroji Uemura

Keyword(s):

Prostate Cancer ◽

Spinal Cord ◽

Clinical Outcome ◽

Spinal Cord Compression ◽

Specific Antigen ◽

Oncological Outcome ◽

Cord Compression ◽

Metastatic Spinal Cord Compression ◽

Reconstruction Surgery ◽

Castration Resistant

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.

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Prostate cancer burden at the Uganda Cancer Institute (UCI).

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.246 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 246-246

Author(s):

Fred Machyo Okuku ◽

Jackson Orem ◽

George Holoya ◽

Christopher J De Boer ◽

Matthew M. Cooney

Keyword(s):

Prostate Cancer ◽

Spinal Cord ◽

Gleason Score ◽

Spinal Cord Compression ◽

Stage Iv ◽

Cord Compression ◽

Screening Programs ◽

Stage Iv Disease ◽

Lost To Follow Up

246 Background: In Uganda prostate cancer is the most common cancer and the incidence is increasing 5.2% annually. This burden is seen without screening programs in a country with limited access to cancer care. Data describing patient presentation and outcomes are lacking. Methods: Retrospective chart review for men with histologically-confirmed prostate cancer at the UCI from January 1 to December 17, 2012. Patient characteristics, treatments, and survival data were obtained. Results: There were 181 men with confirmed prostate cancer [C1] . Mean age was 69.5 (SD 9.0) with a median age of 70 (IQR: 64-75). Men presented with symptoms of lower urinary tract symptoms 73% (n=131), bone pain in 18% (n=32), elevated PSA 3% (n=5) and other causes 6% (n=11). Median baseline PSA was 91.3 ng/ml (IQR: 19.5-311.3 ng/ml) and upon presentation 51.1% (n=92) had a PSA value over 100 ng/ml. Gleason Score was 9 or 10 in 66.7% (n=120), Gleason Score 7 to 8 in 23.4% (n=44), and Gleason six or lower in 10% (n=18). Ninety percent (n=136) of patients had stage IV disease, 6.5% (n=11) were stage III, 11.9% were (n= 20) stage II, and 1 individual (0.6%) had stage I. Common sites of metastases included bone 73% (n=102), visceral metastases 21% (n=29), and lymph node involvement 4% (n=5). Spinal cord compression occurred in 30.9% (n=55) and 5.6% (n=10) experienced a fracture. A total of 14.9% (n=27) patients underwent radical prostatectomy and 17.7% (n=32) received radiotherapy. GNRH agonist was given to 45.3% (n=82) of patients, 29.2% (n=53) of men received diethylstilbestrol, and 26% (n=47) underwent bilateral orchiectomy. Chemotherapy was administered to 21.6% (n=39) and 52.5% (n=95) received bisphosphonates. During the 12 months of study 23.8% (n=43) of men experienced death and 54.4% (n=98) were lost to follow up. Conclusions: UCI patients present with significant symptoms, high PSA, and aggressive Gleason Scores. 90% present with stage IV disease and almost 33% develop spinal cord compression. Prostatectomy and radiotherapy are infrequently given and the primary treatments are hormonal manipulation and chemotherapy. Almost 25% of patients succumb within a year of presentation and there is a high rate of patients lost to follow up.

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Clinical outcome of surgical management for symptomatic metastatic spinal cord compression from prostate cancer

BMC Urology ◽

10.1186/s12894-020-00713-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Yasuhide Miyoshi ◽

Takashi Kawahara ◽

Masahiro Yao ◽

Hiroji Uemura

Keyword(s):

Prostate Cancer ◽

Spinal Cord ◽

Clinical Outcome ◽

Surgical Management ◽

Spinal Cord Compression ◽

Cord Compression ◽

Metastatic Spinal Cord Compression

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Clinical outcome of surgical management for symptomatic metastatic spinal cord compression form prostate cancer.

10.21203/rs.2.14520/v3 ◽

2020 ◽

Author(s):

Yasuhide Miyoshi ◽

Takashi Kawahara ◽

Masahiro Yao ◽

Hiroji Uemura

Keyword(s):

Prostate Cancer ◽

Spinal Cord ◽

Clinical Outcome ◽

Spinal Cord Compression ◽

Specific Antigen ◽

Oncological Outcome ◽

Cord Compression ◽

Metastatic Spinal Cord Compression ◽

Reconstruction Surgery ◽

Castration Resistant

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Spinal Cord Compression by Ligamentum Flavum Hematoma in the Thoracic Spine

Spine ◽

10.1097/brs.0b013e3181b3f87c ◽

2009 ◽

Vol 34 (25) ◽

pp. E942-E944 ◽

Cited By ~ 9

Author(s):

Hideki Sudo ◽

Kuniyoshi Abumi ◽

Manabu Ito ◽

Yoshihisa Kotani ◽

Masahiko Takahata ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Thoracic Spine ◽

Ligamentum Flavum ◽

Cord Compression

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Poster 304: Extramedullary Cavernous Hemangioma of the Thoracic Spine Causing Spinal Cord Compression: A Case Report

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2007.06.720 ◽

2007 ◽

Vol 88 (9) ◽

pp. E99

Author(s):

Bohdan Warycha ◽

Melissa Bednar ◽

Timur Yasin ◽

Muhammad Arif ◽

Paul Pipia

Keyword(s):

Spinal Cord ◽

Case Report ◽

Spinal Cord Compression ◽

Thoracic Spine ◽

Cavernous Hemangioma ◽

Cord Compression

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Surgery for Metastatic Epidural Spinal Cord Compression in Thoracic Spine, Anterior or Posterior Approach?

10.21203/rs.2.334/v1 ◽

2019 ◽

Author(s):

Jen Chung Liao

Keyword(s):

Spinal Cord ◽

Blood Loss ◽

Spinal Cord Compression ◽

Thoracic Spine ◽

Posterior Approach ◽

Cord Compression ◽

Thoracic Vertebrae ◽

Neurologic Status ◽

Significant Difference ◽

Group A

Abstract Background: The most commonly encounter tumor of the spine is metastasis, and thoracic spine is the most commonly metastatic spine. Controversy exists regarding the optimal surgical approach for this kind of patient. The author conducted a study to assess the differences between anterior thoracotomy and posterior approach in patients with malignant epidural cord compression in the thoracic spine. Methods: Between January 2003 and December 2015, patients with metastatic thoracic lesion underwent surgery at our department were stratified into two groups according to different approach method to the lesion site. Group A mean anterior thoracotomy, decompression and fixation. Group P represented posterior decompression and fixation. Survival was defined as months since surgery to last tractable times. American Spinal Injury Association grade was used to assess preoperative and postoperative neurologic status. Days at intensive care unit (ICU) were compared. Every complication by surgery or during admission was documented. Results: Group A had 25 patients and Group P had 67 patients. Lung cancer was ther most commonly origin cancer in both groups. The most commonly surgical level was the 9th thoracic vertebrae in Group A and the 10th thoracic vertbrae in Group P. Both gropus had a similar preoperative neurologic (p=0.959). One patients in Group A and two in the Group P sustained neurologic deterioation immediately after surgery. Group A took more operation time (213.0 vs 199.2 minutes, p=0.380) and had more blood loss (912.5 vs 834.4 ml, p=0.571). 6 patients in Group A (24%) and 10 patients in Group P (13.9%) developed complications immediately or postoperatively. Patients in Group A need more days of care at ICU (2.36 vs 0.19 days, p<0.001). The longer survival was seen in the goup P (15.4 vs 11.2 months) but without significant differnce. Conclusion: Patients in Group P required significantly less days of care at ICU. Besides, posterior approach also took a shorter surgical time, and had a less blood loss during surgery, although without statistically significant difference. According to the results, the author would prefer posterior approach by decompression and fixation for those with thoracic metastatic tumor with epidural compression. Keywords: Thoracic spine; metastatic epidural spinal cord compression; anterior thoracotomy; posterior approach; survivorship; neurologic status; complications.

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