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Treatment of medical emergencies

There are few medical emergencies in patients with prostate cancer. However, because of the predilection of this cancer to metastasize to the spine, the danger of spinal cord compression is always present. Patients with cord compression typically present with minimal symptoms; back pain or sciatic-type pain are the most common complaints. Paresthesias (abnormal touch sensations, such as burning or prickling, that occur without an outside stimulus) and sensory loss may occur but are usually mild. Loss of sphincter control or motor function are typically late signs.

Patients with suspected cord compression should have their spinal cord visualized by MRI or CT myelography. If there is to be any delay in visualizing the spinal cord, administration of steroids, usually in the form of dexamethasone (4-6 mg q6-8h) can avert the development of paralysis. The steroids can then be tapered rapidly if no compression is present. Confirmed spinal cord compression is treated with steroids, followed by irradiation (usually 30 Gy in 10 fractions) to the affected area.

Another method for treating patients with pain from bone metastases is with bisphosphonates. Several new agents are under development, but currently panidronate (Aredia), 90 mg IV given every 3 weeks is the most commonly used agent.

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