Surgery of skeletal metastases in 306 patients with prostate cancer

Purpose

Skeletal metastases are common in patients with prostate cancer, and they can be a source of considerable morbidity. We analyzed patient survival after surgery for skeletal metastases and identified risk factors for reoperation and complications.

Patients and methods

This study included 306 patients with prostate cancer operated for skeletal metastases during 1989–2010. Kaplan-Meier analysis was used to calculate survival. Cox multiple regression analysis was performed to study risk factors, and results were expressed as hazard ratios (HRs).

Results

The median age at surgery was 72 (49–94) years. The median survival after surgery was 0.5 (0–16) years. The cumulative 1-, 2-, and 3-year survival after surgery was 29% (95% CI: 24–34), 14% (10–18), and 8% (5–11). Age over 70 years (HR 1.4), generalized metastases (HR 2.4), and multiple skeletal metastases (HR 2.3) resulted in an increased risk of death after surgery. Patients with lesions in the humerus (HR 0.6) had a lower death rate. The reoperation rate was 9% (n = 31). The reasons for reoperation were deep wound infection (n = 10), hematoma (n = 7), material (implant) failure (n = 3), wound dehiscence (n = 3), increasing neurological symptoms (n = 2), prosthetic dislocation (n = 2), and others (n = 4).

Interpretation

This study involves the largest reported cohort of patients operated for skeletal lesions from prostate cancer. Our survival data and analysis of predictors for survival help to set appropriate expectations for the patients, families, and medical staff.Advances in the treatment of prostate cancer have extended life expectancy (Berruti et al. 2000, Carlin and Andriole 2000, Saad et al. 2006). Approximately 70% of the patients with advanced disease can be expected to develop skeletal metastases (Coleman 2001).The role of orthopedic surgery in patients with skeletal metastases is to treat spinal cord compression and existing or impending pathological fractures in an effort to relieve pain and restore function. Information on outcomes following surgery for skeletal metastases is important for the patients involved, for their families, and for treating physicians (Wedin et al. 2005, Forsberg et al. 2011).Skeletal metastases from other malignancies are most often osteolytic whereas skeletal metastases from prostate cancer are most often osteoblastic, which may mean unique treatment considerations. However, little attention has been paid to survival and postoperative complications in patients with metastatic prostate lesions.We have determined patient survival following surgery for symptomatic skeletal metastases in a large cohort of prostate cancer patients. A secondary aim was to identify patient-related and procedure-related risk factors for complications and reoperation.