| Frequency of screening magnetic resonance imaging to detect occult spinal cord compromise and to prevent neurological deficit in metastatic castration-resistant prostate cancer. | |
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MedLine Citation:
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PMID: 20034772 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIMS: Neurological deficit from malignant spinal cord compression (SCC) is a major complication of metastatic castration-resistant prostate cancer (CRPC). The aims of the present study were to determine the incidence of neurological deficit in metastatic prostate cancer patients and to determine the optimal frequency of screening magnetic resonance imaging (MRI) spine required to detect clinically occult radiological SCC (rSCC). MATERIALS AND METHODS: A retrospective analysis of the clinical data of 130 consecutive patients with CRPC, with no functional neurological deficit, who had screening MRI spine from January 2001 to May 2005, was undertaken. Patients found to have rSCC received radiotherapy. All patients were followed-up to document the incidence of neurological deficit. RESULTS: Thirty-seven (28.4%) patients had rSCC on MRI. The proportion of patients free from neurological deficit at 3, 6, 12, 18 and 24 months was 94, 80, 59 and 43%, respectively, in patients who had rSCC on initial MRI and 97.5, 89, 75 and 63%, respectively, in patients who had no rSCC. A high prostate-specific antigen (PSA) level at initial MRI (P = 0.035) and a short PSA doubling time < 3 months (P = 0.009) significantly predicted for neurological deficit on univariate analysis, whereas back pain (P = 0.059), although an important predictive factor, did not attain statistical significance. On multivariate analysis, only rapid PSA doubling time (<3 months) independently predicted for future neurological deficit (P = 0.042). CONCLUSION: MRI spine can be used to detect asymptomatic rSCC in patients with CRPC and serial estimations are required to maintain a low incidence of clinical SCC. If serial screening MRI spine is used to detect rSCC in 90% of patients before the development of neurological signs, the optimum frequency depends on the subset of patients studied. The results of our study suggest that the optimum frequency would be every 4-6 months for patients with previous SCC, rapid or high PSA or back pain and annually for asymptomatic patients. |
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Authors:
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R Venkitaraman; S A Sohaib; Y Barbachano; C C Parker; R A Huddart; A Horwich; D Dearnaley |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-01-12 |
Journal Detail:
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Title: Clinical oncology (Royal College of Radiologists (Great Britain)) Volume: 22 ISSN: 1433-2981 ISO Abbreviation: Clin Oncol (R Coll Radiol) Publication Date: 2010 Mar |
Date Detail:
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Created Date: 2010-02-15 Completed Date: 2010-05-11 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9002902 Medline TA: Clin Oncol (R Coll Radiol) Country: England |
Other Details:
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Languages: eng Pagination: 147-52 Citation Subset: IM |
Copyright Information:
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2009 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. |
Affiliation:
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Department of Oncology, Ipswich Hospital NHS Trust, UK. ramachandran.venkitaraman@ipswichhospital.nhs.uk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Castration Humans Magnetic Resonance Imaging* Male Middle Aged Neoplasm Staging Neoplasms, Hormone-Dependent / pathology*, radiotherapy Nervous System Diseases / prevention & control* Prostatic Neoplasms / pathology*, radiotherapy Retrospective Studies Risk Factors Spinal Cord Compression / diagnosis*, etiology, therapy Survival Rate Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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C46/A2131//Cancer Research UK |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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