Pubic symphysis osteomyelitis in the prostate cancer survivor: clinical presentation, evaluation, and management.
OBJECTIVE
To describe pelvic bone osteomyelitis in the prostate cancer survivor, to report on clinical presentation and treatment, and to suggest an algorithmic approach to managing this syndrome complex.


METHODS
A retrospective chart review from January 2011 to June 2014 was performed to identify prostate cancer patients with pubic symphysis osteomyelitis at a tertiary-care academic medical center with emphasis on genitourinary cancer survivorship. Data on clinical presentation and outcomes were reviewed.


RESULTS
Ten patients were diagnosed with having osteomyelitis of the pubic symphysis with or without extension into the pubic rami. Three patients had associated rectal fistulas. Four patients had radical prostatectomy, 5 patients received radiotherapy, and 1 patient received high-intensity focused ultrasound as the primary treatment for prostate cancer. The most common presenting symptoms were pelvic and suprapubic pain, difficulty in walking, and recurrent urinary infections at a median of 7 years after prostate cancer treatment (range, 1.5-16 years). Eight of the 10 patients underwent pubic bone debridement with urinary and fecal diversion when needed. Two patients continue to be managed conservatively with suppressive antibiotics owing to low disease burden. Complete resolution of symptoms was noted in patients undergoing operative intervention, without any pelvic ring instability due to pubic bone resection.


CONCLUSIONS
The combination of pelvic pain, difficulty with ambulation, and recurrent infections in a prostate cancer survivor should prompt investigation for pubic bone osteomyelitis-a poorly recognized syndrome complex that is best managed in a multidisciplinary setting.
Department of Urology, University of Kentucky, Lexington, KY. Electronic address: shubham.gupta@uky.edu.
Shubham
S
Gupta
Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC.
Robert D
RD
Zura
Division of Infectious Diseases, Duke University Medical Center, Durham, NC.
Edward F
EF
Hendershot
Division of Urology, Genitourinary Cancer Survivorship Program, Duke University Medical Center, Durham, NC.
Andrew C
AC
Peterson
D000465:Algorithms; D006801:Humans; D008297:Male; D010019:Osteomyelitis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D011471:Prostatic Neoplasms / Q000150:complications*; D011631:Pubic Symphysis; D012189:Retrospective Studies; D017741:Survivors