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May 7, 2013

Treatment of locally advanced prostate cancer

A few weeks ago, I discussed the treatment of a 53-year-old man whose prostate cancer was discovered when it had not spread and who opted to have radiation seed implant. This week I will discuss a case of a patient with cancer of the prostate that had just begun to spread.{{more}}

Mr Dick is a 68-year-old retired public servant who was referred to me with a PSA of 17ng/ml. He had no problems passing his urine, even though he admitted to getting up two times at nights to pass urine. Examination of his prostate revealed an enlarged gland with hard areas on both sides. He was advised to have a prostate biopsy, which he did the next week.The biopsy was uneventful and two weeks later, he was called to the office to discuss the results that confirmed his suspicion.
He had prostate cancer. It was the moderately aggressive type with microscopic evidence that it was beginning to spread. I discussed the options for treatment of his type of cancer and informed him what he ideally needed was an endorectal MRI and an isotope bone scan. These were not available in St Vincent, so he travelled to Trinidad to have them done. I also advised him to see a cancer treatment specialist (oncologist) who specializes in radiation.

The test he had in Trinidad did not show any evidence of cancer far from the prostate on the bone scan, but the MRI suggested that the cancer was beginning to spread out of the prostate, but it had not gone far. He came back to St Vincent after having seen the oncologist because he could not afford the nearly USD$25,000 needed to have radiation treatment. He therefore agreed to have open surgery here in St Vincent. Even though he had medical insurance, he could not afford the out-of-pocket expenses.

The surgery was done at the Milton Cato Memorial Hospital. At the operation, there was no obvious evidence that his local lymph glans were involved, so his prostate and seminal vesicles were removed and the bladder rejoined to the urine passage. The operation took three hours. His surgery and post surgical stay were uneventful. He had a radical retropubic prostatectomy and the cost of the surgery, anaesthetic and all miscellaneous and all hospital costs was less than EC$8,000. Most of this was covered by his insurance company. He was discharged two days after his surgery with a urinary catheter.

The catheter was removed 10 days later and Mr Dick passed urine easily, but he had some difficulty controlling it. He was taught how to do pelvic floor exercises and two weeks later he said the control was getting better.

At six weeks, the urine control was almost back to normal, but he said he had the sense of losing control if he engaged in strenuous activity. The pathology report from the lab indicated that the entire tumor was removed, but there was a little area where the cancer might have breached the capsule or covering of the prostate. He also said his erections had not returned, but he was not too bothered, as his partner was also not bothered. He was, however, advised to start Viagra. This he did and when seen at three months, reported that he was getting “good” erections with the help of Viagra. The PSA at three months was reported as less than 0.01ng/ml (basically unrecordable).

It has been two years now and the PSA is less than 0.1ng/ml. the erections are back, but not as powerful as before, so he uses a small dose of Cialis (the brother to Viagra) sometimes. His urine control is still not as it was before his surgery, but significantly better than before. He has now been placed on a six -monthly follow-up.

For comments or question contact:

Dr Rohan Deshong

Tel: (784) 456-2785