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Metastatic epidural spinal cord compression among elderly patients with advanced prostate cancer

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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.

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Acknowledgments

This study was funded in part by a grant from the Department of Defense (PC094372).

Conflict of interest

None of the authors has a conflict of interest to report. No author has a financial relationship with the organization that sponsored the research. The authors have full control of the data used for analysis in this study. We agree to allow the Journal to review the data, if requested.

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Authors and Affiliations

  1. Department of Urology, College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Benjamin A. Spencer & Mitchell C. Benson

  2. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    Benjamin A. Spencer, Jin Joo Shim, Dawn L. Hershman & Alfred I. Neugut

  3. Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Dawn L. Hershman, Emerson A. Lim & Alfred I. Neugut

  4. Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Brad E. Zacharia

  5. Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Benjamin A. Spencer, Dawn L. Hershman, Emerson A. Lim, Mitchell C. Benson & Alfred I. Neugut

  6. Columbia University Medical Center, 722 West 168th Street, Room 725, New York, NY, 10032, USA

    Alfred I. Neugut

Authors
  1. Benjamin A. Spencer
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  2. Jin Joo Shim
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  3. Dawn L. Hershman
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  4. Brad E. Zacharia
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  5. Emerson A. Lim
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  6. Mitchell C. Benson
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  7. Alfred I. Neugut
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Corresponding author

Correspondence to Alfred I. Neugut.

Additional information

The linked SEER-Medicare database was used in this study. The interpretation and reporting of these data are the sole responsibility of the authors.

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Spencer, B.A., Shim, J.J., Hershman, D.L. et al. Metastatic epidural spinal cord compression among elderly patients with advanced prostate cancer. Support Care Cancer 22, 1549–1555 (2014). https://doi.org/10.1007/s00520-013-2112-0

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  • DOI: https://doi.org/10.1007/s00520-013-2112-0

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