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

Benjamin A. Spencer, Jin Joo Shim, Dawn L. Hershman, Brad E. Zacharia, Emerson A. Lim, Mitchell C. Benson, Alfred I. Neugut

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1549-1555
Number of pages7
JournalSupportive Care in Cancer
Issue number6
StatePublished - Jun 2014

All Science Journal Classification (ASJC) codes

  • Oncology


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