Related Experiment Video
Updated: Aug 11, 2025
Diffusion Tensor Magnetic Resonance Imaging in Chronic Spinal Cord Compression
Published on: May 7, 2019
A Novel Radiographic Pattern Related to Poor Prognosis in Patients with Prostate Cancer with Metastatic Spinal Cord
Johan Wänman1, Kasim Abul-Kasim2, Julius Semenas3
1Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University, Umeå, Sweden.
Background:
Prostate cancer spinal bone metastases can have a radiographic profile that mimics multiple myeloma.
Objective:
To analyse the presence and prognostic value of myeloma-like prostate cancer bone metastases and its relation to known clinical, molecular, and morphological prognostic markers.
Design Setting And Participants:
A cohort of 110 patients with prostate cancer who underwent surgery for metastatic spinal cord compression (MSCC) was analysed. Spinal bone metastases were classified as myeloma like (n = 20) or non-myeloma like (n = 90) based on magnetic resonance imaging prior to surgery. An immunohistochemical analysis of metastasis samples was performed to assess tumour cell proliferation (percentage of Ki67-positive cells) and the expression levels of prostate-specific antigen (PSA) and androgen receptor (AR). The metastasis subtypes MetA, MetB, and MetC were determined from transcriptomic profiling.
Outcome Measurements And Statistical Analysis:
Survival curves were compared with the log-rank test. Univariate and multivariate Cox proportional hazard models were used to assess the effects of prognostic variables. Groups were compared using the Mann-Whitney U test for continuous variables and the chi-square test for categorical variables.
Results And Limitations:
Patients with the myeloma-like metastatic pattern had median survival after surgery for MSCC of 1.7 (range 0.1-33) mo, while the median survival period of those with the non-myeloma-like pattern was 13 (range 0-140) mo (p < 0.001). The myeloma-like appearance had an independent prognostic value for the risk of death after MSCC surgery (adjusted hazard ratio 2.4, p = 0.012). Postoperative neurological function was significantly reduced in the myeloma-like group. No association was found between the myeloma-like pattern and morphological markers of known relevance for this patient group: the transcriptomic subtypes MetA, MetB, and MetC; tumour cell proliferation; and AR and PSA expression.
Conclusions:
A myeloma-like metastatic pattern identifies an important subtype of metastatic prostate cancer associated with poor survival and neurological outcomes after surgery for MSCC.
Patient Summary:
This study describes a novel radiographic pattern of prostate cancer bone metastases and its relation to poor patient prognosis.
