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March 19, 2013

Treatment of early stage prostate cancer

Over the last few weeks I was discussing prostate cancer. Last session, I discussed the principles of treating prostate cancer. This week, I will discuss the treatment of early stage prostate cancer, using typical examples of men who come to the office. In other words, I’m not discussing an actual patient, I’m just using the example of a typical patient. Let’s call this patient Mr John James. Here is his story.{{more}}

Mr James is a 55-year-old self-employed small businessman, whose PSA was 3.5ng/ml four years ago, when he visited his doctor for his regular yearly checks. He missed his last appointment three years ago, because he was overseas, but when he did his annual one year later, his PSA had gone up to 4.8ng/ml. He was not too worried, but his doctor still sent him to see me for a second opinion.
 
When I saw him, he did not report any problems with his urine and on examination, I noted that his prostate was smooth and benign feeling. The prostate was not enlarged for his age and measured 25 grams on an office ultrasound. His urine test showed no signs of infection. I therefore advised him to have a biopsy or a sample test, which he did two weeks later, under local anaesthetic and antibiotic cover.

The results of the test showed a small cancerous growth in one area of the left side of his prostate. There was no evidence of microscopic spread and the cancer was not the aggressive type. I discussed the results with his wife and daughter and it was agreed that he could wait for a few months until he got the money he needed to go overseas to have radiation seeds implanted into his prostate. He made this decision with my advice, as he did not want to have surgery because he was afraid of surgery, as his father had died after surgery for bowel cancer at age 76, ten years ago, in the US.

He was placed on a pill to “keep his cancer under control” until he got the money for the radiation seeds. Six months later, he travelled to Trinidad and had the seeds implanted. Today, he is doing well. He has no problems controlling his urine and his erection problem, which he had for four months after the seed implant is almost completely resolved; however, he still uses Viagra every “now and then”. It has been 18 months since his seed implant and his PSA is now 0.14ng/ml and most likely will continue like this for another five to 10 years.

This patient had all his treatment right here in the Caribbean. If he had opted for surgery, this could have been done in St Vincent. The cost of his seed implant in Trinidad was US$18,000. He did not need other tests before his seed implant because his PSA was less than 10, his prostate felt normal and his cancer was not aggressive; in other words, he was diagnosed when his cancer had not spread.
 
He came when it was early. He could have also decided to not do anything for his cancer for a year or two until there was evidence that the “cancer was moving” or until he decided that he had gathered enough courage to have his surgery. He could even have had the outside type radiation (called external beam radiation) if he really did not want the 30 minute anaesthetic to put in the seeds. In other words, when you are diagnosed with prostate cancer in the early stages, if it is not aggressive, then you have time to decide which of the many effective and even experimental treatments you want.

Mr James was not offered any of the experimental treatments because they are only available in North America and Europe and because of his age, I advised him to have effective and curative treatment. Next week, we will look at another case.

For comments or question contact:

Dr Rohan Deshong

Tel: (784) 456-2785

email: deshong@vincysurf.com

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