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Bone metastases are common in prostate cancer, with the spine being the most frequent site. Using data from the Swedish Spine Register (Swespine) and Prostate Cancer Database Sweden (PCBaSe), 306 men with prostate cancer who underwent spinal surgery were identified. In total, 81 were categorized as castration-sensitive and 225 as castration-resistant disease at the time of spinal surgery. Postoperative survival was estimated using Kaplan\u2013Meier analysis and compared with the log-rank test. Multivariable Cox regression was used to adjust for potential confounders. Median survival after surgery was significantly longer in men with castration-sensitive prostate cancer (33\u00a0months, IQR 15\u201355) compared to those with castration-resistant disease (8\u00a0months, IQR 5\u201331; p\u2009&lt;\u20090.001). Castration-sensitive status was independently associated with a lower risk of death (hazard ratio 0.29, 95% CI: 0.20\u20130.41). These findings indicate that castration sensitivity is a strong prognostic factor for survival after surgery for spinal metastases from prostate cancer and should be considered in surgical decision-making.<\/jats:p>","DOI":"10.1038\/s41598-025-34335-2","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T17:23:59Z","timestamp":1767806639000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Survival after spinal surgery for metastases in men with castration-sensitive vs castration-resistant prostate cancer: a nationwide register-based study"],"prefix":"10.1038","volume":"16","author":[{"given":"Johan","family":"W\u00e4nman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehdy","family":"Farhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Nystr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Styrke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christel","family":"H\u00e4ggstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e4r","family":"Stattin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sead","family":"Crnalic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"34335_CR1","first-page":"209","volume":"71","author":"H Sung","year":"2021","unstructured":"Sung, H. et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin. 71, 209\u2013249 (2021).","journal-title":"CA Cancer J. Clin."},{"issue":"5","key":"34335_CR2","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1053\/hp.2000.6698","volume":"31","author":"L Bubendorf","year":"2000","unstructured":"Bubendorf, L. et al. Metastatic patterns of prostate cancer: An autopsy study of 1,589 patients. Hum. Pathol. 31(5), 578\u2013583. https:\/\/doi.org\/10.1053\/hp.2000.6698 (2000).","journal-title":"Hum. Pathol."},{"issue":"9","key":"34335_CR3","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1016\/j.trecan.2024.06.005","volume":"10","author":"J Corres-Mendizabal","year":"2024","unstructured":"Corres-Mendizabal, J. et al. Metastatic hormone-naive prostate cancer: A distinct biological entity. 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Predictive value of the spinal instability neoplastic score for survival and ambulatory function after surgery for metastatic spinal cord compression in 110 patients with prostate cancer. Spine 8, 550\u2013558 (2020).","journal-title":"Spine"},{"key":"34335_CR10","doi-asserted-by":"publisher","unstructured":"Crnalic, S., L\u00f6fvenberg, R., Bergh, A. et al.\u00a0Predicting survival for surgery of metastatic spinal cord compression in prostate cancer: A new score.\u00a0Spine (Phila Pa 1976) 37, 2168\u20132176. https:\/\/doi.org\/10.1097\/BRS.0b013e31826011bc (2012).","DOI":"10.1097\/BRS.0b013e31826011bc"},{"key":"34335_CR11","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1186\/s12894-020-00713-3","volume":"1","author":"Y Miyoshi","year":"2020","unstructured":"Miyoshi, Y. et al. Clinical outcome of surgical management for symptomatic metastatic spinal cord compression from prostate cancer. 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The authors declare that they have no competing interests related to the present study. The study was funded by grants from the Swedish Prostate Cancer Federation, Lion\u2019s Cancer Research Foundation at Ume\u00e5 University, and through a regional agreement between Ume\u00e5 University and Region V\u00e4sterbotten (ALF).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"Due to the retrospective nature of the study, the Swedish Ethical Review Authority waived the need of obtaining informed consent.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent statement"}}],"article-number":"887"}}