ITEMS IN AFP WITH MESH TERM:
ABSTRACT: Neurologic complications continue to pose problems in patients with metastatic prostate cancer. From 15 to 30 percent of metastases are the result of prostate cancer cells traveling through Batson's plexus to the lumbar spine. Metastatic disease in the lumbar area can cause spinal cord compression. Metastasis to the dura and adjacent parenchyma occurs in 1 to 2 percent of patients with metastatic prostate cancer and is more common in those with tumors that do not respond to hormone-deprivation therapy. Leptomeningeal carcinomatosis, the most frequent form of brain metastasis in prostate cancer, has a grim prognosis. Because neurologic complications of metastatic prostate cancer require prompt treatment, early recognition is important. Physicians should consider metastasis in the differential diagnosis of new-onset low back pain or headache in men more than 50 years of age. Spinal cord compression requires immediate treatment with intravenously administered corticosteroids and pain relievers, as well as prompt referral to an oncologist for further treatment.
ABSTRACT: Acute lumbar disk herniations are the most common cause of sciatica. After excluding emergent causes, such as cauda equina syndrome, epidural abscess, fracture, or malignancy, a six-week trial of conservative management is indicated. Patients should be advised to stay active. If symptoms persist after six weeks, or if there is worsening neurologic function, imaging and invasive procedures may be considered. Most patients with lumbar disk herniations improve over six weeks. Because there is no difference in outcomes between surgical and conservative treatment after two years, patient preference and the severity of the disability from the pain should be considered when choosing treatment modalities. If a disk herniation is identified that correlates with physical findings, surgical diskectomy may improve symptoms more quickly than continued conservative management. Epidural steroid injections can also provide short-term relief.