Progressive computed tomography (CT) appearances preceding malignant spinal cord compression (MSCC) in men with castration-resistant prostate cancer

•MSCC is a common and devastating complication in CRPC patients.•Screening for MSCC is not performed, but men have regular staging CT scans.•We assessed CTs prior to MSCC for abnormal epidural and paravertebral signs.•Abnormal signs were visible in up to 80% of MSCC patients on prior CT scans.•Presence of these signs on CT should prompt consideration of MRI spine.

AimTo test the hypothesis that computed tomography (CT)-based signs might precede symptomatic malignant spinal cord compression (MSCC) in men with metastatic castration-resistant prostate cancer (mCRPC).Materials and methodsA database was used to identify suitable mCRPC patients. Staging CT images were retrospectively reviewed for signs preceding MSCC. Signs of malignant paravertebral fat infiltration and epidural soft-tissue disease were defined and assessed on serial CT in 34 patients with MSCC and 58 control patients. The presence and evolution of the features were summarized using descriptive statistics.ResultsIn MSCC patients, CT performed a median of 28 days prior to the diagnostic magnetic resonance imaging (MRI) demonstrated significant epidural soft tissue in 28 (80%) patients. The median time to MSCC from a combination of overt malignant paravertebral and epidural disease was 2.7 (0–14.6) months. Conversely, these signs were uncommon in the control cohort.ConclusionsSignificant malignant paravertebral and/or epidural disease at CT precede MSCC in up to 80% of mCRPC patients and should prompt closer patient follow-up and consideration of early MRI evaluation. These CT-based features require further prospective validation.