WHEN ADDITION TREATMENT FOR PROSTATE CANCER MAY BE NEEDED: SPINAL CORD COMPRESSION

About one-third of men with metastatic prostate cancer may be at risk for spinal cord compression—when proliferating cancer cells cause part of the spinal column to collapse, trapping and sometimes crushing nearby nerves. If you have severe pain in your back that accompanies leg weakness, loss of sensation (often beginning with numbness or tingling in the toes), trouble walking, constipation or urinary retention, you may be at risk, and you need an MRI scan right away. An MRI scan is essential—it gives details of the spinal cord and can show early signs ofcompression. If spinal cord compression is an immediate danger, the MRI will show the cancer invading the dura, the membrane surrounding the spinal cord; this is called extradural compression. If your hospital doesn’t have an MRI machine, it’s worth it to make arrangements to travel to another hospital. This is a very serious problem—a true emergency— and it requires aggressive, immediate treatment. It is far better to treat potential spinal cord compression early than to try and repair the damage after it happens.

Patients in imminent danger of spinal cord compression should be treated with large doses of corticosteroids (usually a drug called decadron) for forty-eight hours. Then, depending on how your body responds to this, your doctor will make a decision on what to do next—this could mean spot radiation treatment to the spine, or something called surgical decompression, an operation to ease the cancer’s pressure on the spinal cord.

If you have not yet begun hormone therapy, now is an excellent time to begin—and fast—with immediate castration or treatment with flutamide (see above). Giving an LHRH agonist alone in this situation is not a good idea, because it can cause a surge in testosterone that could aggravate the cancer sitting so precariously in the spine.

Spinal cord compression is yet another blow in a series of unpleasant complications of prostate cancer, and it has the greatest potential to ruin quality of life—it can lead to paralysis, with an accompanying loss of bowel and bladder function. Most significantly, it can result in the loss of a patient’s independence and feeling of dignity.

If you begin to feel any of the warning signs mentioned above, call your doctor immediately; don’t wait until your next scheduled appointment! This may mean the difference between remaining able to walk and being bedridden.

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