Surgical treatment for prostate cancer in patients with prior spinal cord injury

Limited published information is available concerning the clinical course of spinal cord-injured (SCI) patients who develop prostate carcinoma and subsequently undergo radical surgery. We hypothesized that the choice of surgical treatment and the technical conduct of radical surgery would be influenced by sequelae of SCI and that poorer outcomes would result in this population as compared with neurally intact patients. A nationwide study was conducted of all SCI veterans receiving care at Department of Veterans Affairs Medical Centers who subsequently developed prostate carcinoma and underwent curative-intent radical operations between 1993 and 2002. Only patients with complete SCI due to trauma who met American Spinal Injury Association type A criteria were analyzed. The unpaired t-test was used to analyze data. Of 16,878 patients who underwent radical operations for prostate cancer, 55 had preexisting diagnostic codes for SCI. After record review, 14 met all inclusion criteria. The mean age was 57 years. All were asymptomatic with clinically organ-confined disease diagnosed by an increased prostate-specific antigen level or abnormal digital rectal examination results. Comorbid conditions were present in 9 (69%) of 13 patients. Twelve underwent radical prostatectomy, and two underwent cystoprostatectomy. There were no operative deaths, but 8 (57%) of 14 had complications (P < .05). The mean length of stay (16 days) was significantly longer (P < .05) than in neurally intact patients. SCI patients tended to be younger than neurally intact patients with prostate cancer, and the rate of cystoprostatectomy was high. The complication rate was significantly higher and the hospital stay was significantly longer than in neurally intact patients.