Long-term Survival in a Patient with Metastatic Spinal Cord Compression from a Prostate Cancer with Ultra-high PSA: Case Report and Review of the Literature

TL;DR

A man with severe prostate cancer and spinal cord compression unexpectedly survived for over 7.5 years after treatment.

Contribution

This case report highlights an unusually long survival in a prostate cancer patient with severe metastatic spinal cord compression.

Findings

The patient fully recovered function and survived over 7.5 years despite a poor prognosis.

Factors like pre-treatment ambulation and single metastasis site were linked to better outcomes in literature review.

Longer radiation therapy courses and absence of prior ADT correlated with improved local control and survival.

Abstract

A 77-year-old man presented to the hospital for non-ambulation of 48 hours prior to admission.  He was found to have a metastatic spinal cord compression (MSCC), a PSA exceeding 27,000, and biopsy-confirmed prostate cancer. After palliative radiation (RT) to the spine and medical treatment, the patient recovered his functions fully and survived for more than 7.5 years, far beyond what would be expected based on current published literature.

A systematic review of the literature of MSCC in patients with prostate cancer was carried out. Prognostic factors of ambulation after RT included pre-treatment neurological status, duration of neurological deficits, and severity of the neurological impairment. Positive predictive factors of local control included single level of metastasis, time of development of motor deficits of more than 14 days, no prior androgen-deprivation therapy (ADT), age under 65, and longer course of RT (10 fractions of 2 Gy). Absence of prior ADT, pre-treatment ambulation, a single site of metastasis, and haemoglobin of less than 12g/L were positive predictors for survival.