The role of surgical management for symptomatic spinal cord compression in patients with metastatic prostate cancer.

Spinal cord compression is a devastating complication of metastatic prostate cancer. We reviewed the experience at our center with 28 patients who underwent laminectomy for spinal cord compression secondary to adenocarcinoma of the prostate between January 1980 and November 1985. Patient age ranged from 46 to 82 years (mean age 65.5 years). The most common presenting complaints were back pain (75 per cent), loss of sensation (68 per cent) and loss of bladder function (39 per cent in retention). Postoperatively, 22 patients (79 per cent) had improvement of the presenting complaints. Of the 13 bedridden patients at presentation 8 (62 per cent) were ambulatory postoperatively. Of the 11 patients in retention 6 (55 per cent) were able to void postoperatively. There was no perioperative mortality. Four patients required further surgery, 2 had postoperative pneumonia and there were 2 wound infections. The average postoperative life span for the 17 patients not surviving to last followup was 9.5 months (range 1 to 60 months). The management of prostate cancer patients who have back pain and/or neurological findings is discussed. We believe that the rate of palliation and improved quality of life that decompressive laminectomy can afford patients with spinal cord compression due to prostate cancer justify its use in patients medically fit for the procedure.