The Paradox of Prevention: How Prophylactic Surgery Accelerated Decline in Metastatic Cancer
Nicholas W Tyndall1, Franchesca Farris-Cosme1, Nicholas Phan2
1Internal Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, USA.
Cureus
|May 18, 2026
Summary
Prophylactic surgery for bone metastases in advanced prostate cancer can prevent fractures but may hasten decline in frail elderly patients. Shared decision-making and palliative care are crucial for patient-centered outcomes.
Area of Science:
- Oncology
- Orthopedic Surgery
- Palliative Care
Background:
- Metastatic castration-resistant prostate cancer (mCRPC) frequently causes bone metastases, increasing pathological fracture risk.
- Prophylactic fixation, guided by scoring systems like Mirels, is common but poses challenges in elderly, frail patients.
- The physiological stress of surgery may outweigh benefits in advanced disease, impacting quality of life.
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