Cancer of the prostate in myelopathy patients: lower risk with higher levels of paralysis.
The prevalence of cancer of the prostate (CAP) among patients with myelopathy is lower among the more severely paralyzed. The objective of this study was to determine whether this phenomenon could be more precisely defined. Men 50 years of age or older who were registered with the spinal cord injury (SCI) service of the Department of Veterans Affairs Medical Center (West Roxbury, Massachusetts) in 1989 were classified by level and grade of paralysis. Cases of CAP were identified by review of the hospital tumor registry and autopsies over the ensuing 11 years. The difference in the incidence of CAP between patients with high and low levels of paralysis was tested by comparison of proportions. Eight cases of CAP were found in 2594 patient-years of follow-up. CAP developed in 3 of 218 patients paralyzed at C2 to T10 and in 5 of 60 patients paralyzed at T11 to S2. Incidence rates were 0.15 versus 0.91 per 100 patient-years, respectively (P = .015). When patients with incomplete paralysis were excluded, the incidence rates were 0 and 2.1 per 100 patient-years for the higher and lower lesions, respectively (P < .001). The incidence of CAP is lower in myelopathy patients with higher levels of paralysis (T10 or above) than in those with lesions at T11 or below.