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May 28, 2013

Advanced prostate cancer

This week is our final article in the prostate cancer series, in which we discuss advanced or late stage prostate cancer. This is prostate cancer that has already spread. The story below is an example.{{more}}

John Browne is a 55-year-old labourer who started having lower back pains three months ago. He ignored the pain because he thought it was because of his job that involved a lot of bending. Two months later, he started losing weight and appetite and developed chest pain and shortness of breath when he did simple tasks. Interestingly, he had no urinary problems. At his wife’s insistence, he went to see the district doctor who did his PSA, among other tests. The doctor called me and asked me to see Mr Browne because his PSA was 2,500ng/ml (normally 4ng/ml).
 
I saw this gentleman and noted that he had lost weight and he was anemic. I examined his prostate and found a hard irregular lump that essentially replaced the prostate. The other blood test confirmed the presence of advanced prostate cancer, namely a low blood count (8.4g%) and a high Alkaline Phosphatase (a test for cancer spreading to the bones). I sent him for a chest X-ray and X-rays of the remainder of the bones in his body and started him on treatment for his prostate cancer that clinically had already spread over his body.

I started him on medication for his prostate cancer, pain and to build his blood. Two days later, when seen with his X-rays, he had less pain and, as suspected, his X-rays showed that he had cancer all over the bones of his body. At this time, I did a simple digital guided biopsy of his prostate, because he could not afford to have one done properly at the private facility. He also expressed concerns getting the medication for cancer, as the hospital had none and he could not afford to buy them privately at over EC$300 per month. We discussed the other viable option for this gentleman, which included removal of his testicles (because the male hormone testosterone is made in the testicles and this hormone acts as a “fertilizer” for the cancer). He said he would try to get the money for the medication.

Two weeks later, he had got some money to buy only enough medication for the month. The pathology report from the biopsy confirmed my fears that his cancer was aggressive. It was given a score of 8/10 in terms of aggressiveness. I told him to finish his month of cancer treatment and then repeat his PSA. This he did and when seen two weeks later, he was smiling, as his appetite has gotten better and he had put on weight. He also said that his pain had gotten better, even though he had stopped taking his pain medication. His PSA was now down to 510ng/ml and again he expressed financial concerns.
 
Again, I encouraged him to take the minor surgery. He eventually agreed one week later and had the minor operation the following week. He said he was hesitant to have the operation, because he was afraid of “losing his nature”, which he admitted he had lost for over six months before he was diagnosed with prostate cancer, but he assumed that it was “age setting in”. The minor surgery was uneventful and he had a complete recovery with no complications. Six weeks after the operation his PSA was 4.2ng/ml and three months later it was 1.4ng/ml. It has now been 18 months since he was first diagnosed and his PSA is 1.1ng/ml, on no other cancer treatment.
 
 He is pain free, his appetite is normal and his blood count is 12.2g%. He has not had any “hard” erections on his own, but says he gets “soft” ones in the mornings. He has used Viagra to good effect, but he is afraid of using it constantly because of all the bad publicity surrounding Viagra. I have encouraged him to continue using them. He continues to be seen every three months. This man is an example of the many men who come to me at “death’s door” with advanced prostate cancer. Unfortunately, not all have been helped because of misinformation, fear and taboos. He made the hard decisions and is alive to tell the tale.

For comments or question contact:

Dr Rohan Deshong

Tel: (784) 456-2785

email: deshong@vincysurf.com

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