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Abstract
Bone metastases occur in up to 90% of patients with advanced breast or prostate cancer. Spinal cord compression (SCC) is an oncologic emergency and is considered a complication of bone metastases. If SCC is left untreated, it can result in a loss of feeling, motor control, and eventually paralysis. In most cases, cancer will be first diagnosed in early stages. We present the case of a 71 year-old male who, upon initial presentation, had a spinal cord compression and associated lower extremity weakness and gait difficulty. At this time, he had no prior history of cancer or confirmed tissue diagnosis of cancer.
Keywords: Cancer, palliative radiotherapy, spinal cord compression
Introduction
In 2011, there were 240,890 new diagnoses of prostate cancer with 33,720 deaths from the disease in the United States (1). Men with well-differentiated prostate cancer have an excellent prognosis, often surviving 10-20 years without intervention (1). Prostate cancer often presents with localized symptoms such as bladder outlet obstruction, but terminal stages can be associated with bone pain and weight loss (1).
One of the most common sites of prostate cancer metastasis is the bone. Bone metastases can cause extreme pain and skeletal-related events (SRE) such as fracture and spinal cord compression (SCC) (2). Spinal cord compression is an unfortunate complication that results from extradural tumor growth along the spinal cord or vertebral collapse from tumour growth within the vertebrae (3). Metastatic epidural SCC occurs in 5-14% of cancer patients (4).
In the case of prostate cancer, men who are at risk are screened regularly using a prostate-specific antigen (PSA) test. If cancer is suspected, an ultrasound in addition to a biopsy may help confirm the diagnosis. The use of both of these tools increases the chance of detecting prostate cancer early. As a result of appropriate screening regimens, SCC is infrequently the first presentation of prostate cancer. However, even if not shown by a PSA test, patients may detect local symptoms of prostate cancer, including bladder outlet obstruction. In the rare case of an undetected cancer metastasizing to bone, bone pain is often the first symptom that triggers diagnosis of the underlying malignancy.
In this report we...