Prognostic implication of gait function following treatment for spinal cord compression in men diagnosed with prostate cancer.

Background: Malignant spinal cord compression (MSCC) is a severe complication of metastatic prostate cancer (PCa) and may compromise neurological functions, including gait function. This study aimed to evaluate the association between survival and gait function prior to, immediately after and 6 weeks following radiotherapy for MSCC in PCa patients. Patient sample: All PCa patients admitted with MSCC at Rigshospitalet, Denmark from January 1, 2010 to December 31, 2011 were included. Patients were followed until death to analyze gait function as a prognostic factor. Methods: Of the 76 included patients, four patients underwent surgical decompression followed by radiotherapy and 72 patients received only radiotherapy. Gait was evaluated prior to radiotherapy, immediately after radiotherapy and at 6 weeks follow-up. Results: Before radiotherapy, 88% had normal gait function and 12% had complete loss of gait function. Corresponding percentages after radiotherapy were 72% and 28%, respectively. Median overall survival following MSCC was 4.9 months (95% CI = 3.6-6.2) with a 3-, 6-, and 12-months survival probability of 64%, 42%, and 21%, respectively. Multivariate analyses demonstrated that patients without gait function after radiotherapy had a 2.6-2.8-fold increased risk of dying compared to men with gait function. Patients with more than two vertebrae involved had a 2.3-3.4-fold increased risk of dying when compared to patients with 1-2 vertebral metastases. Conclusions: PCa patients with MSCC have a poor prognosis. Most likely reflecting differences in tumor burden, preserved gait function following radiotherapy is associated with better prognosis. Further prospective studies are required to confirm this association.