Spinal cord compression is not an uncommon occurrence in men with advanced prostate cancer. Bones are the most common target of advanced prostate cancer, including the spine. Sadly, there is often a delay in diagnosing spinal cord compression resulting from prostate cancer. These delays in diagnosis can influence the eventual functional outcome.

Oncologists, primary care doctors and emergency room physicians need to become familiar with this problem so they can quickly diagnosis the problem and quickly refer their patients for surgery. Without a fast referral, their patient might not regain their ability to walk!

A recent study was done to examine current practice for referral and diagnosis of prostate cancer patients with spinal cord compression and to identify prognostic factors for neurological outcome after surgery.

The researchers conducted a small study consisting of 68 consecutive patients with prostate cancer who underwent surgery due to neurological compromise. Intervals from onset of neurological symptoms to referral, diagnosis, and treatment were analyzed in relation to functional outcome. Then the researchers evaluated the significance of preoperative clinical parameters on gait function one month after surgery.

They found that the men who were referred from local hospitals had longer delay to surgery than those who directly presented to the cancer center (p = 0.004). The rate of diagnosis with MRI increased through the week and peaked on Friday, with few patients being diagnosed during weekends.

The ability to walk before surgery, hormone-naive prostate cancer, and/or shorter time from loss of ambulation were clearly associated with better neurological outcomes. In men who had castrate resistant prostate cancer who were unable to walk before surgery regaining ambulation was associated with: duration of paresis < 48 hours (p = 0.005), good preoperative performance status (p = 0.04), preoperative PSA serum level < 200 ng/ml (p = 0.03), and surgery with posterior decompression and stabilization (p = 0.03).The conclusions were clear, early diagnosis and rapid treatment of spinal cord compression in men with prostate cancer is directly linked with positive neurological recovery. Raising awareness of the among both patients at risk and among physicians is of utmost importance. Treatment guidelines must be written to insure that spinal compression is quickly diagnosed and treated.
Reference: Acta Oncol. 2012 Sep 3. Epub ahead of print.
doi: 10.3109/0284186X.2012.705437: Crnalic S, Hildingsson C, Bergh A, Widmark A, Svensson O, Löfvenberg R. Department of Surgical and Perioperative Sciences, Orthopedics, Umeå University, Umeå, Sweden.

Joel T. Nowak, M.A., M.S.W.