Metastatic spinal cord compression in prostate cancer: clinical and morphological studies

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MARC

Crnalic, Sead,1960-Umeå universitet,Ortopedi (author)

Metastatic spinal cord compression in prostate cancer : clinical and morphological studies

BookEnglish2012

Publisher, publication year, extent ...

Umeå :Umeå universitet,2012
44 s.
electronicrdacarrier

Numbers

LIBRIS-ID:oai:DiVA.org:umu-54461
ISBN:9789174593891
https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-54461URI

Supplementary language notes

Language:English
Summary in:English

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SwePubSwePub

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Subject category:vet swepub-contenttype
Subject category:dok swepub-publicationtype

Varying forms of title

Ryggmärgskompression vid metastaserande prostatacancer :kliniska och morfologiska studier

Series

Umeå University medical dissertations,0346-6612 ;1487

Notes

Background: Bone metastases occur in most patients with advanced hormone-refractory prostate cancer causing pain, pathologic fractures, and spinal cord compression. Few studies specifically address surgical treatment of metastatic spinal cord compression (MSCC) in prostate cancer. Criteria for identifying patients who may benefit from surgery are poorly defined. Most of the current knowledge regarding tumor biology in prostate cancer is based on studies of primary tumors or soft tissue metastases. The mechanisms regulating growth of bone metastases are not fully established. Aims: a) to evaluate outcome after surgery for MSCC in prostate cancer and to identify prognostic factors for survival and functional recovery; b) to evaluate current practice for referral of prostate cancer patients with MSCC; c) to analyze expression of androgen receptor (AR), cell proliferation, apoptosis, and prostate-specific antigen (PSA) in bone metastases with regard to survival after surgery for complications of bone metastases. Patients and Methods: We retrospectively evaluated the hospital records of 68 consecutive patients operated for metastatic spinal cord compression. Tumor tissue from bone metastases was obtained on spinal surgery (54 patients), fracture surgery (4 patients) and biopsy (2 patients), and analyzed by immunohistochemistry. Results: Study I: Mortality and complication rate after surgery was high. Patients with hormone-naïve disease and those with hormone-refractory disease with good performance status and without visceral metastases had more favorable survival. The ability to walk after surgery was related to better survival. Study II: A new score for prognosis of survival after surgery for spinal cord compression includes: hormone status of prostate cancer, Karnofsky performance status, evidence of visceral metastasis, and preoperative serum PSA. The score is simple, tumor specific, and easy to apply in clinical practice. Study III: Our results suggest that delays in diagnosis and treatment may have negative impact on functional outcome. Pretreatment ability to walk, hormone status of prostate cancer, and time from loss of ambulation influenced neurological recovery after surgery for spinal cord compression. Study IV: High nuclear AR immunostaining in bone metastases and high preoperative serum PSA were associated with a poor outcome after metastasis surgery in patients with hormone-refractory prostate cancer. Short-term effect of castration therapy disclosed that nuclear AR immunostaining was decreased and apoptosis was increased, but cell proliferation remained largely unaffected. Conclusion: Prostate cancer patients with metastatic spinal cord compression represent a heterogeneous group. We identified prognostic factors for survival and functional outcome, which may help clinicians in making decisions about treatment. Our results also implicate the need for development of local and regional guidelines for treatment of patients with spinal cord compression, as well as the importance of information to patients at risk.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Ortopedi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Orthopaedics hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Cancer och onkologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cancer and Oncology hsv//eng
prostate cancer
bone metastasis
spinal cord compression
surgical treatment
survival prognosis
early diagnosis
androgen receptor
Orthopaedics
ortopedi
Pathology
patologi
Oncology
onkologi

Added entries (persons, corporate bodies, meetings, titles ...)

Löfvenberg, Richard,DocentUmeå universitet,Ortopedi(Swepub:umu)rilo0004 (thesis advisor)
Widmark, Anders,ProfessorUmeå universitet,Onkologi(Swepub:umu)anwi0004 (thesis advisor)
Bergh, Anders,ProfessorUmeå universitet,Patologi(Swepub:umu)anbe0010 (thesis advisor)
Nilsson, Sten,ProfessorInstitutionen för Onkologi - Patologi, Karolinska Institutet, Stockholm (opponent)
Umeå universitetOrtopedi (creator_code:org_t)

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Orthopaedics

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