What is metastatic spinal cord compression (MSCC)?

MSCC happens when cancer cells that have spread from the prostate grow in or near to the spine and press on the spinal cord. You might hear it called malignant spinal cord compression or spinal cord compression.

The spinal cord is a long, thin bundle of nerves and other cells. It runs from your brain down through your spine. The nerves carry messages between your brain and all parts of the body. These messages allow you to move and to feel things like heat, cold, touch or pain. They also help control body temperature and how your internal organs work.

Cancer cells pressing on the spinal cord can cause problems with how these messages are carried. This can cause a range of symptoms that can get worse if left untreated. For example, you may be less able to walk and move around.

At its worst, MSCC can cause nerve damage and even paralysis. This could mean you can’t walk or use your arms or legs normally. Remember, there are treatments available and getting treatment straight away can lower the risk of this happening, or of it being permanent.

What is my risk of developing MSCC?

MSCC isn’t common, but you need to be aware of the risk if your prostate cancer has spread to your bones or has a high risk of spreading to your bones. Your risk of MSCC is highest if your prostate cancer has already spread to your spine.

Speak to your doctor or nurse for more information about your risk of MSCC.

What symptoms do I need to watch out for?

MSCC can cause any of the following symptoms.

  • Pain or soreness in your lower, middle or upper back or neck. The pain might be severe or get worse over time. It might get worse when you cough, sneeze, lift or strain, go to the toilet, or lie down. It may wake you at night or stop you from sleeping.
  • A narrow band of pain around your chest or abdomen (stomach area) that can move towards your back, buttocks or legs.
  • Pain that moves down your arms or legs.
  • Weakness or loss of control of your arms or legs, or difficulty standing or walking. You might feel unsteady on your feet or feel as if your legs are giving way. Some people say they feel clumsy.
  • Numbness or tingling (pins and needles) in your legs, arms, fingers, toes, buttocks, stomach area or chest that doesn’t go away.
  • Problems controlling your bladder or bowel. You might not be able to empty your bladder or bowel, or you might have no control over emptying them.

These symptoms can also be caused by other conditions, but it's still important to get medical advice straight away in case you do have MSCC.

What should I do if I get symptoms?

If you get any of the symptoms listed above, you should get medical advice straight away. Don’t wait to see if your symptoms get better and don’t worry if you think it’s an inconvenient time, such as the evening or weekend.

Ask your doctor or nurse to write down who you should contact during the day, at night, and at the weekend.

If you don’t have details of who to contact, or you can't reach them, go to your nearest accident and emergency (A&E) department. MSCC can be hard to diagnose, especially if you have other health problems. It can sometimes be mistaken for general back pain, or bone pain caused by your cancer. So it’s important to tell the A&E staff that you have prostate cancer and symptoms of spinal cord compression. Not everyone will be familiar with MSCC, so it might be a good idea to show them this web page, or take our fact sheet on metastatic spinal cord compression or other information about MSCC with you.

What will happen if my doctor thinks I have MSCC?

If your doctor thinks you may have MSCC, you will need to have a magnetic resonance imaging (MRI) scan to look at your spine. If you can't have an MRI scan, you may have a computerised tomography (CT) scan instead. Read more about scans.

While you are waiting for a diagnosis, there are a number of things that can be done to make you more comfortable and to help protect your spinal cord from further harm.

  • Pain relief. There are a number of ways to treat the pain caused by MSCC and by the cancer in other parts of your body, including pain-relieving drugs. Read more about ways to manage pain caused by advanced prostate cancer.
  • A steroid called dexamethasone. This works quickly to reduce swelling and relieve pressure on the spinal cord. You’ll be given a daily dose as tablets or a drip into a vein in your arm. The dose will be gradually reduced and stopped if your symptoms improve or you start another treatment. You might also be given tablets to help prevent the steroids irritating your stomach.
  • Bed rest. You might be asked to lie flat on your back while you’re waiting for a diagnosis. This helps keep your spine still and can reduce the risk of further damage to your spinal cord. Lying down will also stop you from falling over if you’re finding it difficult to stand up or walk. You might be given support stockings to wear while you’re lying in bed, to help prevent blood clots. Your doctor or nurse will monitor your condition and let you know when it’s safe for you to gradually sit up.

How is MSCC treated?

If you are diagnosed with MSCC, you should start treatment as soon as possible – ideally within 24 hours. Your doctor will explain the different treatment options to help you decide what’s right for you. They will consider your wishes as far as possible. They will also support you and your family after treatment to help you recover from MSCC.

There are two main treatments available  you may be offered one of these, or your doctor may suggest having both.

  • Radiotherapy. This aims to shrink the cancer cells that are pressing on your spinal cord. It can also help to relieve the pain. High-energy X-ray beams are directed at the affected area from outside the body. This is known as external beam radiotherapy. You may have one or more treatment sessions – your medical team will discuss this with youRead more about radiotherapy for advanced prostate cancer.
  • Surgery. Surgery is sometimes used to treat MSCC. Your doctor will discuss this with you if it’s suitable for you. It usually aims to reduce the pressure on your spinal cord and makes your spine more stable. Surgery is sometimes done at a specialist spinal unit. You might be given radiotherapy once you’ve recovered from surgery, to shrink any areas of cancer that might be left in the spine.

If radiotherapy or surgery aren’t suitable for you, or if your spine still needs support after treatment, you may be offered a support brace or collar. This fits around your back or neck and helps to support your spine. It can also help with pain. Speak to your doctor or nurse about whether a support brace or collar might be helpful for you.

What happens after treatment?

MSCC can affect men in different ways. Getting treatment early can reduce the risk of long-term problems, but for some men it can take weeks or months to recover. Sometimes the effects can last longer or are permanent. Your doctor or nurse at the hospital will make sure you get the support you need.

If MSCC means that you’re less able to walk and move around, a physiotherapist can show you exercises that can help. An occupational therapist (OT) can make sure you have the right equipment in your house so that you’re comfortable and can move about more easily.

Your doctor will also look at the treatments you are having for your prostate cancer, to see if they need changing. Read about treatments that can help control the growth of prostate cancer or ways to manage symptoms of advanced prostate cancer.

What is my outlook?

Some men with MSCC want to know if it will affect how long they will live. This is sometimes called your outlook or prognosis.

If you have MSCC, this means your cancer is advanced and cannot be cured. MSCC itself doesn’t affect how long you will live. But it could affect your ability to walk and move around if it isn’t treated quickly. And it may be a sign that your cancer is becoming more advanced. Read more about advanced prostate cancer and how to get support.

No one can tell you exactly what your outlook will be as it will depend on many things such as your general health, where your cancer has spread to, how quickly it is spreading, and how well you respond to treatments. But if your doctor has explained that you are approaching the end of your life, you may want to read our information about dying from prostate cancer. It includes information on what to expect as your cancer progresses, and how to deal with different thoughts and feelings you might have. It also has information on sorting out practical things, such as organising your finances and making an up-to-date Will, as well as thinking about how and where you might want to be cared for.

Information for partners and family

Families can find this a difficult time and they may want support and information too. We have information for partners, family and friends, including ways you can support someone with prostate cancer and look after yourself. We also have specific information if you are supporting someone who is approaching the end of their life. And all of our support services are available to partners, family members and friends.

What to read next

References

Updated: February 2019 | Due for review: February 2022

  • List of references  

    • Al-Qurainy R, Collis E. Metastatic spinal cord compression: diagnosis and management. BMJ. 2016 May 19;353:i2539.
    • Crnalic S, Hildingsson C, Bergh A, Widmark A, Svensson O, Löfvenberg R. Early diagnosis and treatment is crucial for neurological recovery after surgery for metastatic spinal cord compression in prostate cancer. Acta Oncol Stockh Swed. 2013 May;52(4):809–15.
    • George R, Jeba J, Ramkumar G, Chacko AG, Tharyan P. Interventions for the treatment of metastatic extradural spinal cord compression in adults. In: The Cochrane Collaboration, editor. Cochrane Database of Systematic Reviews [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2015 [cited 2016 Apr 13]. Available from: http://doi.wiley.com/10.1002/14651858.CD006716.pub3
    • Husband DJ. Malignant spinal cord compression: prospective study of delays in referral and treatment. BMJ. 1998 Jul 4;317(7150):18–21.
    • Husson O, Mols F, Poll-Franse LV van de. The relation between information provision and health-related quality of life, anxiety and depression among cancer survivors: a systematic review. Ann Oncol. 2010 Sep 24;mdq413.
    • Loblaw DA, Mitera G, Ford M, Laperriere NJ. A 2011 updated systematic review and clinical practice guideline for the management of malignant extradural spinal cord compression. Int J Radiat Oncol. 2012;84(2):312–7.
    • Mottet N, Van den Bergh RCN, Briers E, Bourke L, Cornford P, De Santis M, et al. EAU - ESTRO - ESUR - SIOG Guidelines on Prostate Cancer. European Association of Urology; 2018.
    • National Collaborating Centre for Cancer. Metastatic spinal cord compression: diagnosis and management of patients at risk of or with metastatic spinal cord compression. 2008.
    • National Institute for Health and Care Excellence (NICE). Metastatic spinal cord compression in adults - quality standard 56. 2014.
    • National Institute for Health and Care Excellence. Metastatic spinal cord compression: Diagnosis and management of adults at risk of and with metastatic spinal cord compression. NICE clinical guideline 75 [Internet]. 2008. Available from: https://www.nice.org.uk/guidance/cg75
    • Pettersson A, Johansson B, Persson C, Berglund A, Turesson I. Effects of a dietary intervention on acute gastrointestinal side effects and other aspects of health-related quality of life: A randomized controlled trial in prostate cancer patients undergoing radiotherapy. Radiother Oncol. 2012 Jun;103(3):333–40.
    • Samphao S, Eremin JM, Eremin O. Oncological emergencies: clinical importance and principles of management. Eur J Cancer Care (Engl). 2010;19(6):707–13.
    • Steinberg M. Degarelix: A gonadotropin-releasing hormone antagonist for the management of prostate cancer. Clin Ther. 2009 Jan;31:2312–31.
  • List of reviewers  

    • Jenny Draper, Day Hospice Clinical Nurse Specialist, Meadow House Day Hospice, Ealing
    • Charlotte Etheridge, Lead Macmillan Urology Clinical Nurse Specialist, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust
    • Conor Fitzpatrick, Consultant Radiographer in Palliative Radiotherapy, The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral
    • Nikola Hawkins, Consultant Allied Health Professional and Cancer Rehabilitation Lead, Gloucestershire Care Services NHS Trust
    • Peter Hoskin, Consultant Clinical Oncologist, Mount Vernon Cancer Centre, Middlesex, and Professor of Clinical Oncology, University of Manchester
    • Our Specialist Nurses
    • Our volunteers.