Appropriate Frequency of Spinal MRI Scans in Men With Metastatic CRPC

ProstateCancerInfoLink.net | 01.16.2010

Spinal cord compression (SCC) is a major complication of metastatic castration-resistant prostate cancer (CRPC) and the onset of SCC is associated with potentially severe neurological problems. Targeted radiotherapy can be used to delay or prevent the progression of SCC, but is most effective when SCC is detected as early as reasonably possible.

Venkitaraman et al. have attempted to determine the optimal frequency of spinal magnetic resonance imaging (MRI) to detect SCC by analyzing clinical data from 130 consecutive patients with CRPC.

These patients had no functional neurological deficit, and all received spinal MRIs between January 2001 and May 2005. Patients found to have SCC were treated with radiotherapy. All patients were followed to document the incidence of neurological deficit.

The results of this study showed the following:

•37/130 patients (28.4 percent) had SCC on MRI.
•The number of patients with SCC and free from neurological deficit gradually declined: from 94 percent at three months to 43 percent at 24 months.
•The number of patients without SCC and free from neurological deficit also declined over the same timeframe: from 97.5 percent to 63 percent at 24 months.
•The only independent predictive factor of future neurological deficit was a PSA doubling time of less than 3 months.

The authors conclude that spinal MRIs can be used to detect asymptomatic SCC in patients with CRPC. They further note that serial MRIs are required to maintain a low incidence of clinical SCC and that the optimum frequency of the MRIs depends on the subset of patients studied.

They suggest, based on the results of their study, that the optimal frequency for spinal MRIs would be every four to six months for CRPC patients with previous SCC, rapid or high PSA, or back pain -- and annually for patients with CRPC but no symptoms suggestive of SCC.

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