Issue 01/April 2024

From Benign to Malignant: A 78 Year Old's Battle with Prostate Health

By: Dr. Rushikumar Panchal

The journey of a 78-year-old patient with urinary difficulties sheds light on the complexities of prostate health management. Back in 2011, the patient initially sought medical attention for urinary complaints, prompting evaluations including rectal exams and transdigital assessments of prostate enlargement. A diagnosis of benign prostatic enlargement was reached, and treatment ensued, effectively alleviating symptoms. Regular monitoring of PSA levels indicated stability until 2016, when a rise to 25 prompted another comprehensive evaluation, revealing no concerning findings.

Fast forward to December 2023, the patient experienced a resurgence of urinary symptoms, coinciding with a spike in PSA levels to 76. Further investigations, including digital transrectal sonography and PET scans, unveiled a significant lesion in the right lobe of the prostate, indicating adenocarcinoma with intermediate risk staging. Faced with two treatment options—radical prostate radiotherapy or surgery—the patient opted for the former with the intent to cure. 

Under the guidance of Dr. Rushi Panchal, renowned for his expertise in the field, radiotherapy commenced in February. Initially, there was promising progress in reducing the size of the enlarged prostate. However, complications emerged, including hemorrhagic and radiation cystitis, alongside pre-renal azotemia and blood clot obstruction, necessitating the premature termination of radiotherapy in the last two days of treatment.

By the second week of March, the patient's symptoms had subsided, with normalized creatinine levels, urine flow, and PSA levels. This case underscores the latent nature of prostate cancer, which can remain asymptomatic for extended periods despite a 12-year disease-free interval. Both surgical and radiotherapeutic interventions pose risks, including urinary incontinence, with hormonal treatments occasionally increasing the likelihood of cardiovascular events. In modern practice, radical radiotherapy techniques aim to minimize collateral damage to adjacent organs, making them a preferred choice for many patients.

In this particular case, adjuvant hormonal therapy with lupride and calutide was initiated alongside radiotherapy, leading to a rapid normalization of PSA levels. This highlights the effectiveness of combined treatments in managing prostate cancer.

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