# Survival after spinal surgery for metastases in men with castration-sensitive vs castration-resistant prostate cancer: a nationwide register-based study

## TL;DR

Men with castration-sensitive prostate cancer have longer survival after spinal surgery for metastases compared to those with castration-resistant disease.

## Contribution

This study identifies castration sensitivity as a strong prognostic factor for survival after spinal surgery for prostate cancer metastases.

## Key findings

- Median survival was 33 months for castration-sensitive vs 8 months for castration-resistant prostate cancer.
- Castration-sensitive status was independently associated with a 71% lower risk of death.
- Castration sensitivity should be considered in surgical decision-making for spinal metastases.

## Abstract

This nationwide register-based cohort study examined the association between castration status and postoperative survival in men who had undergone surgery for spinal metastases from prostate cancer. Bone metastases are common in prostate cancer, with the spine being the most frequent site. Using data from the Swedish Spine Register (Swespine) and Prostate Cancer Database Sweden (PCBaSe), 306 men with prostate cancer who underwent spinal surgery were identified. In total, 81 were categorized as castration-sensitive and 225 as castration-resistant disease at the time of spinal surgery. Postoperative survival was estimated using Kaplan–Meier analysis and compared with the log-rank test. Multivariable Cox regression was used to adjust for potential confounders. Median survival after surgery was significantly longer in men with castration-sensitive prostate cancer (33 months, IQR 15–55) compared to those with castration-resistant disease (8 months, IQR 5–31; p < 0.001). Castration-sensitive status was independently associated with a lower risk of death (hazard ratio 0.29, 95% CI: 0.20–0.41). These findings indicate that castration sensitivity is a strong prognostic factor for survival after surgery for spinal metastases from prostate cancer and should be considered in surgical decision-making.

The online version contains supplementary material available at 10.1038/s41598-025-34335-2.