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

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.

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

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.

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

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.

Characterization of metastatic spinal cord compression from prostate cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 248-248
Author(s):  
Jianbo Wang
Keyword(s):  
Prostate Cancer ◽  
Spinal Cord ◽  
Bone Metastasis ◽  
Clinical Outcome ◽  
Gleason Score ◽  
Spinal Cord Compression ◽  
Thoracic Spine ◽  
Radiation Treatment ◽  
Cord Compression ◽  
Anatomical Site

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]

Prognostic implication of gait function following treatment for spinal cord compression in men diagnosed with prostate cancer

2019 ◽  
Vol 53 (4) ◽  
pp. 222-228 ◽  
Author(s):  
Caroline Sophie Lehrmann-Lerche ◽  
Frederik Birkebæk Thomsen ◽  
Martin Andreas Røder ◽  
Morten Hiul Suppli ◽  
Klaus Brasso ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Prognostic Implication ◽  
Gait Function

Comparison of two Different Radiotherapy Schedules for Spinal Cord Compression in Prostate Cancer

1998 ◽  
Vol 84 (4) ◽  
pp. 472-477 ◽  
Author(s):  
Ernesto Maranzano ◽  
Paolo Latini ◽  
Sara Beneventi ◽  
Luigi Marafioti ◽  
Fabrizio Piro ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Response Rate ◽  
Recovery Of Function ◽  
Performance Status ◽  
Cord Compression ◽  
Severe Toxicity ◽  
Indwelling Catheter ◽  
Short Course

Aims and background To assess the clinical outcome and toxicity of two different radiotherapy (RT) schedules for the management of metastatic spinal cord compression from prostate cancer, we performed a prospective analysis of 44 patients with the complication. Methods Two different RT schedules were adopted, a split-course regimen of 5 Gy x 3, 4 days rest, and then 3 Gy x 5, and a short-course regimen of 8 Gy, 7 days rest, and then 8 Gy. The split-course RT was adopted for all prostate cancer patients referred to our center between 1986 and 1992. Starting in 1993, the short-course RT was added for patients with a poor prognosis (i.e., paresis or paraplegia, low performance status, and/or short life expectation), whereas others still underwent the split-course regimen. So, 27 (61%) patients were treated with the split-course and the other 17 (39%) with the short-course regimen. Medium follow-up was 48 months (range, 6 to 123). Results Back pain total response rate was 82%. Effectiveness of RT on motor and bladder capacity was conditioned by pretreatment status of patients. All 20 (100%) walking cases maintained the function, whereas 11 of 24 (46%) with motor impairment regained the ability. The difference in response rate was statistically significant (P<0.001). All 36 (100%) patients, able to void at presentation preserved the capacity, whereas 3 of 8 (38%) with sphincter dysfunction no longer needed an indwelling catheter. Posttreatment neurologic status was the only factor found to affect survival. Median survival, 9 months for the whole group, was 10 and 2 months for posttreatment walking and nonwalking patients, respectively (10 vs 2 months, P<0.001). Neither presence of other metastases nor RT regimen used (split vs short-course) conditioned response rate, duration of response or survival. Acute or late, severe toxicity was never recorded. No patient complained of spinal cord morbidity. Conclusions Both split-course and short-course RT schedules were effective and without complications. Early diagnosis was the most important prognostic factor, but there was also recovery of function in about half of the patients unable to walk, and about one-third of patients with bladder dysfunction before treatment. Since length of the course of therapy is a factor with an important impact on the patient's quality of life, the short-course RT regimen adopted in the trial merits further investigation.

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