Elevated prostate specific antigen (PSA) levels a risk factor for pathological hip fracture in metastatic prostatic carcinoma

Metastatic carcinoma of the prostate is increasing in incidence and commonly affects the proximal femur, but fracture risk is difficult to predict. Prophylactic fixation may avert the technical problems and reduce post-operative complications associated with acute pathological fracture treatment. This is a retrospective study of 14 patients who sustained a pathological fracture in the proximal femur from prostatic metastases. Risk factors for fracture were assessed, peri-operative complications highlighted and patient survival noted. At time of the initial diagnosis of prostate carcinoma, 12/14 patients (86%) had uptake in the proximal femur on isotope bone scan and 11/14 (79%) had an initial prostate specific antigen (PSA) level above 100 ng/ml. A higher initial PSA level correlated with a shorter time to fracture. The subtrochanteric region was the most common fracture location and was technically the most demanding to fix. Blood loss and transfusion requirements were high. Post-operative survival was 71%, 50% and 36% at 6, 12 and 18 months, respectively. From our findings, we suggest that patients with a greatly elevated PSA (>100 ng/ml), a positive isotope bone scan and plain X-ray changes in the proximal femur are at high risk of fracture and should be referred early for prophylactic stabilisation.