title: Early diagnosis and treatment is crucial for neurological recovery after surgery for metastatic spinal cord compression in prostate cancer.
abstract: BACKGROUND
  Spinal cord compression is an oncological and surgical emergency. Delays in referral and diagnosis may influence functional outcome. It is therefore important to identify patients who will regain or maintain the ability to walk after surgery. The aim of the present study was 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.
  
  
  METHODS
  The study includes 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. The prognostic significance of preoperative clinical parameters on gait function one month after surgery was evaluated.
  
  
  RESULTS
  Patients 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 associated with more favorable neurological outcome. In patients with hormone-refractory disease 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).
  
  
  CONCLUSIONS
  Early diagnosis and rapid treatment of spinal cord compression in prostate cancer patients is crucial for neurological recovery. Raising awareness of the condition among patients at risk and among physicians is of outmost importance as well as improving local and regional guidelines for treatment.
authors.affiliation: Department of Surgical and Perioperative Sciences, Orthopedics, Umeå University, Umeå, Sweden. sead.crnalic@orthop.umu.se
authors.forename: Sead
authors.initials: S
authors.lastname: Crnalic
authors.forename: Christer
authors.initials: C
authors.lastname: Hildingsson
authors.forename: Anders
authors.initials: A
authors.lastname: Bergh
authors.forename: Anders
authors.initials: A
authors.lastname: Widmark
authors.forename: Olle
authors.initials: O
authors.lastname: Svensson
authors.forename: Richard
authors.initials: R
authors.lastname: Löfvenberg
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D019299:Decompression, Surgical / Q000379:methods; D042241:Early Diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000209:etiology* / Q000534:rehabilitation / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000556:secondary*; D013997:Time Factors; D016896:Treatment Outcome