title: Metastatic epidural spinal cord compression among elderly patients with advanced prostate cancer.
abstract: BACKGROUND
  A recent randomized trial demonstrated that for metastatic epidural spinal cord compression (MESCC), a complication of advanced prostate cancer, surgical decompression may be more effective than external beam radiation therapy (RT). We investigated predictors of MESCC, its treatment, and its impact on hospital length of stay for patients with advanced prostate cancer.
  
  
  METHODS
  We used the SEER-Medicare database to identify patients >65 years with stage IV (n = 14,800) prostate cancer. We used polytomous logistic regression to compare those with and without MESCC and those hospitalized for treatment with surgical decompression and/or RT.
  
  
  RESULTS
  MESCC developed in 711 (5 %) of patients, among whom 359 (50 %) received RT and 107 (15 %) underwent surgery ± RT. Median survival was 10 months. MESCC was more likely among patients who were black (OR 1.75, 95 %CI 1.39-2.19 vs. white) and had high-grade tumors (OR 3.01, 95 %CI 1.14-7.94), and less likely in those younger; with prior hormonal therapy (OR 0.73, 95 %CI 0.62-0.86); or with osteoporosis (OR 0.63, 95 %CI 0.47-0.83). Older patients were less likely to undergo either RT or surgery, as were those with ≥1 comorbidity. Patients with high-grade tumors were more likely to undergo RT (OR 1.92, 95 %CI 1.25-2.96). Those who underwent RT or surgery spent an additional 11 and 29 days, respectively, hospitalized.
  
  
  CONCLUSIONS
  We found that black men with metastatic prostate cancer are more likely to develop MESCC than whites. RT was more commonly utilized for treatment than surgery, but the elderly and those with comorbidities were unlikely to receive either treatment.
authors.affiliation: Department of Urology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Spencer
authors.forename: Jin Joo
authors.initials: JJ
authors.lastname: Shim
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
authors.forename: Brad E
authors.initials: BE
authors.lastname: Zacharia
authors.forename: Emerson A
authors.initials: EA
authors.lastname: Lim
authors.forename: Mitchell C
authors.initials: MC
authors.lastname: Benson
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000473:pathology / Q000628:therapy; D018426:SEER Program; D013117:Spinal Cord Compression / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy; D013125:Spinal Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000556:secondary* / Q000628:therapy; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data