Symptomatic spinal cord involvement in prostate cancer

The literature on spinal cord involvement in prostate cancer is reviewed by searching the Medline from 1965 to 1997 and references in publications on the subject. The objective was to identify the clinical characteristics and treatment modalities of the disease. Prostate cancer is the leading cause of metastatic spinal cord disease in men. The tumour reaches the spinal column mainly by the venous route. The frequency of involvement in decreasing order is thoracic spine, lumbar spine and cervical spine. The tumour usually exerts compression of the cord from the extradural space. However, intradural and intramedullary metastases have devastating effects. The patients have other neurological and urological symptoms prior to the onset of paraplegia. But in some, spinal cord compression may be the first symptom of prostate cancer. Plain X-rays may suffice in diagnosis but MRI is the single most valuable investigation for anatomic definition or localization of spinal cord secondaries. All forms of treatment are palliative. Treatment options, singly or in combination, include hormonal manipulation, radiotherapy and laminectomy each often with high dose corticosteroids. Recurrence of symptoms after an initial relief with hormonal manipulation signifies escape of the tumour from endocrine control and portends a poor prognosis.