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.