SPINAL-CORD COMPRESSION IN PROSTATE-CANCER

Approximately 200,000 men will be diagnosed with prostate cancer in 19 94. While localized disease is potentially curable with surgery or rad iation therapy, metastatic disease is incurable. The most frequent sit e of metastasis is bone. Spinal cord compression occurs in approximate ly 7% of men with prostate cancer. Back pain often heralds the diagnos is of spinal cord compression. In prostate cancer patients with back p ain or signs of myelopathy or radiculopathy, plain radiographs of the spine and magnetic resonance imaging should be performed. Early diagno sis is of utmost importance. The neurologic status prior to treatment is the major determinant influencing outcome. Following diagnosis, cor ticosteroid therapy should begin immediately. Hormonal therapy should be instituted in those patients who have not previously undergone horm onal manipulation. The standard approach to definitive therapy is radi ation. Surgical decompression plays a role in patients with severe mye lopathy, spinal instability, and in those patients whose neurologic st atus deteriorates during or after radiation therapy.