title: Progressive computed tomography (CT) appearances preceding malignant spinal cord compression (MSCC) in men with castration-resistant prostate cancer.
abstract: OBJECTIVE
  To test the hypothesis that computed tomography (CT)-based signs might precede symptomatic malignant spinal cord compression (MSCC) in men with metastatic castration-resistant prostate cancer (mCRPC).
  
  
  METHODS
  A database was used to identify suitable mCRPC patients. Staging CT images were retrospectively reviewed for signs preceding MSCC. Signs of malignant paravertebral fat infiltration and epidural soft-tissue disease were defined and assessed on serial CT in 34 patients with MSCC and 58 control patients. The presence and evolution of the features were summarized using descriptive statistics.
  
  
  RESULTS
  In MSCC patients, CT performed a median of 28 days prior to the diagnostic magnetic resonance imaging (MRI) demonstrated significant epidural soft tissue in 28 (80%) patients. The median time to MSCC from a combination of overt malignant paravertebral and epidural disease was 2.7 (0-14.6) months. Conversely, these signs were uncommon in the control cohort.
  
  
  CONCLUSIONS
  Significant malignant paravertebral and/or epidural disease at CT precede MSCC in up to 80% of mCRPC patients and should prompt closer patient follow-up and consideration of early MRI evaluation. These CT-based features require further prospective validation.
authors.affiliation: Prostate Cancer Targeted Therapy Group, Academic Urology Unit and Diagnostic Radiology Department, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK.
authors.forename: C
authors.initials: C
authors.lastname: Pezaro
authors.affiliation: Prostate Cancer Targeted Therapy Group, Academic Urology Unit and Diagnostic Radiology Department, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK.
authors.forename: A
authors.initials: A
authors.lastname: Omlin
authors.affiliation: Prostate Cancer Targeted Therapy Group, Academic Urology Unit and Diagnostic Radiology Department, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK.
authors.forename: R
authors.initials: R
authors.lastname: Perez-Lopez
authors.affiliation: Prostate Cancer Targeted Therapy Group, Academic Urology Unit and Diagnostic Radiology Department, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK.
authors.forename: D
authors.initials: D
authors.lastname: Mukherji
authors.affiliation: Prostate Cancer Targeted Therapy Group, Academic Urology Unit and Diagnostic Radiology Department, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK.
authors.forename: G
authors.initials: G
authors.lastname: Attard
authors.affiliation: Prostate Cancer Targeted Therapy Group, Academic Urology Unit and Diagnostic Radiology Department, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK.
authors.forename: D
authors.initials: D
authors.lastname: Bianchini
authors.affiliation: Prostate Cancer Targeted Therapy Group, Academic Urology Unit and Diagnostic Radiology Department, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK.
authors.forename: D
authors.initials: D
authors.lastname: Lorente
authors.affiliation: Prostate Cancer Targeted Therapy Group, Academic Urology Unit and Diagnostic Radiology Department, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK.
authors.forename: C
authors.initials: C
authors.lastname: Parker
authors.affiliation: Prostate Cancer Targeted Therapy Group, Academic Urology Unit and Diagnostic Radiology Department, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK.
authors.forename: D
authors.initials: D
authors.lastname: Dearnaley
authors.affiliation: Prostate Cancer Targeted Therapy Group, Academic Urology Unit and Diagnostic Radiology Department, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK.
authors.forename: J S
authors.initials: JS
authors.lastname: de Bono
authors.affiliation: Prostate Cancer Targeted Therapy Group, Academic Urology Unit and Diagnostic Radiology Department, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK.
authors.forename: A
authors.initials: A
authors.lastname: Sohaib
authors.affiliation: Prostate Cancer Targeted Therapy Group, Academic Urology Unit and Diagnostic Radiology Department, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Downs Road, Sutton, Surrey, UK. Electronic address: nina.tunariu@icr.ac.uk.
authors.forename: N
authors.initials: N
authors.lastname: Tunariu
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D064129:Prostatic Neoplasms, Castration-Resistant / Q000473:pathology; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging*; D013120:Spinal Cord Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary; D014057:Tomography, X-Ray Computed