Routine screening MRI and pre-emptive treatment for spinal cord compression in patients with asymptomatic castration-resistant prostate cancer is not justified, according to UK-based researchers.

In an open-label, randomised controlled trial, they found spinal MRI, followed by treatment as needed, did not significantly reduce the risk of progression from radiological spinal cord compression (rSCC) to clinical SCC (cSCC) compared with no screening.

“MRI screen-detected early rSCC does not always progress to cSCC with contemporary systemic management of castration-resistant prostate cancer and observation might be sufficient” for early epidural SCC, Dr Emma Hall, of The Institute of Cancer Research, in London, and colleagues note.

They also point out that, despite a substantial incidence of rSCC in the screening group, the rate of cSCC was low in both groups at a median of 22 months of follow-up.