Introduction: Patients with hormone refractory prostate cancer (HRPC) with metastatic spine disease (MSD) are at risk of epidural tumor progression. The purpose of this analysis was to delineate the characteristics of the patient population undergoing surgery for the treatment of prostate cancer metastatic to the spine.
Methods: A retrospective chart review was performed on all patients treated at our institution from June 1993 to August 2014 for surgical management of MSD from prostate cancer.
Results: From a cohort of 139 patients with MSD requiring surgery, 121 patients underwent 136 operations for decompression of high-grade epidural spinal cord compression (ESCC). The median age at diagnosis of MSD was 65. HRPC was present in 90% of patients at surgery. Of 136 lesions with high-grade ESCC, 73 had circumferential involvement on imaging. Median time from the MSD diagnosis to surgery was 633 days. In this group, 69% failed prior radiation with a median dose 30Gy in 3Gy/fraction. Preoperatively, 69% had a motor deficit and 24% were non-ambulatory. Separation surgery was performed in 87.5% of patients. The complication rate was 28% and 6.6% required re-operation for recurrence. Postoperative radiation was given in 51% of patients using a variety of radiation schemes. Motor deficits improved in 42% and 78% of non-ambulatory patients regained ambulation with assistance or independently. Median follow-up and overall survival was 5.4 months and 6 months, respectively.
Conclusions: While patients with hormone-sensitive prostate cancer are unlikely to develop symptomatic spinal cord compression, patients with HRPC are at an increased risk of requiring spinal surgery, indicating the aggressive nature of this disease. Close monitoring of patients with MSD after prostate cancer becomes hormone refractory is therefore, recommended.
Patient Care: Ninety percent of patients undergoing spinal surgery for the treatment of prostate metastases in our study were refractory to hormone therapy. This indicates that while patients with hormone-sensitive prostate cancer are unlikely to develop symptomatic spinal cord compression or spinal instability requiring surgery, patients with HRPC are at an increased risk of requiring spinal surgery. Furthermore, a significant number of these patients present with neurologic deficits attributable to spinal cord compression indicating the aggressive nature of this disease. Close monitoring of patients with MSD after prostate cancer becomes hormone refractory is therefore, recommended.
Learning Objectives: By the conclusion of this session, the participants should be able to:
1. Understand surgical indications for metastatic prostate cancer to the spine
2. Describe aggressive nature of hormone refractory prostate cancer (HRPC) metastatic to spine
3. Understand that patients with HRPC more often present with neurological symptoms and therefore, require close monitoring for epidural progression