Cervical spinal cord compression as an initial presentation of prostate cancer: a case report

Prostate cancer is notorious for its atypical presentation. However, spread to the cervical spine is uncommon. We herein describe the findings in a 57-year-old African American gentleman, who presented with neck pain and right-sided weakness. Examination revealed neck tenderness with numbness in the distribution of C6 region on right side. An MRI of the neck imaged a 3.4cm extradural soft tissue mass in the C6 region extending into the spinal-canal, causing spinal cord compression. At this point, differential diagnosis included: metastatic cancer vs. chronic granulomatous vs. primary CNS lesion. Management included high dose intravenous steroids and mass resection with cervical-spine fusion. The prostate specific antigen (PSA) was 1815 ng/mL (normal less than 4 ng/mL) with a repeat value of 1666 ng/mL, and the pathology findings confirmed the mass to be metastatic prostate carcinoma. This case illustrates an unusual presentation of metastatic prostate cancer, lytic in nature, presenting as cord compression, and sparing the bone and lymph nodes in the cervical region. Metastatic lesions of prostate cancer to the bone are most often blastic rather than lytic in nature. Cervical involvement is seen in only 5% of cases. Regardless of this atypical presentation, early diagnosis of cord compression is of utmost importance because neurologic status upon presentation has important prognostic value. It is important to consider prostate cancer metastasis in any compressive neuropathy, or findings of an atypical mass affecting the cervical spine.