Pre-emptive or reactive? PROMPT spinal screening in metastatic castration-resistant prostate cancer.

Abstract

Approximately 1–15% of patients with metastatic castration-resistant prostate cancer eventually develop spinal cord compression (SCC) during their disease. 1 Tazi H Manunta A Rodriguez A Patard JJ Lobel B Guillé F Spinal cord compression in metastatic prostate cancer. Eur Urol. 2003; 44: 527-532 Summary Full Text Full Text PDF PubMed Scopus (39) Google Scholar , 2 Sutcliffe P Connock M Shyangdan D Court R Kandala NB Clarke A A systematic review of evidence on malignant spinal metastases: natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression. Health Technol Assess. 2013; 17: 1-274 Crossref Scopus (85) Google Scholar Guidelines recommend urgent investigation in case of clinical suspicion to diagnose and treat SCC with surgical decompression or radiotherapy, or both. 3 Vellayappan BA Kumar N Chang EL Sahgal A Sloan AE Lo SS Novel multidisciplinary approaches in the management of metastatic epidural spinal cord compression. Future Oncol. 2018; 14: 1665-1668 Crossref PubMed Scopus (5) Google Scholar However, a third of patients with asymptomatic metastatic castration-resistant prostate cancer have radiological signs of SCC by MRI, 4 Venkitaraman R Sohaib SA Barbachano Y et al. Detection of occult spinal cord compression with magnetic resonance imaging of the spine. Clin Oncol (R Coll Radiol). 2007; 19: 528-531 Summary Full Text Full Text PDF PubMed Scopus (33) Google Scholar which raises the question of whether screening followed by treatment of asymptomatic SCC might prevent the development of clinical symptoms of pain and debilitating neurological deficits. Observation versus screening spinal MRI and pre-emptive treatment for spinal cord compression in patients with castration-resistant prostate cancer and spinal metastases in the UK (PROMPTS): an open-label, randomised, controlled, phase 3 trialDespite the substantial incidence of rSCC detected in the intervention group, the rate of cSCC in both groups was low at a median of 22 months of follow-up. Routine use of screening MRI and pre-emptive treatment to prevent cSCC is not warranted in patients with asymptomatic castration-resistant prostate cancer with spinal metastasis. Full-Text PDF Open Access