Prostatic metastasis

By Tedler D. Depaynos, MD

“ Prostatic metastases are very insidious. It may be applicable to other cancer lesions also but it is best to be aware especially the males entering their retiring age. ”

We was a prominent lawyer who was diagnosed to have prostatic cancer at an early stage. Although at times he looked depressed he was mostly seen with wide smiles striding to the hospital for his regular treatment. It was one of his hospital visits when suddenly he experienced difficulty in breathing. On his chest x–ray his urologist as well as the radiologists in the hospital could see sudden metastatic lesions. On further careful examination the new lesions appear not to be consistent with prostatic metastasis especially if it was correlated clinically. Further studies were done and more experienced colleagues were consulted and they were agreeable that the metastasis came from another unknown lesion for apparently the several series of blood tests done for his metastatic prostatic cancer were negative. He appeared to be recovering from his original malady. His prostatic cancer treatment was successful!
Prostatic cancer metastasis has distinct characteristics on x–ray which only expert and experienced eyes could discern especially in the bone. Clinical correlation however is mostly the deciding factor. Of course there were some who disagreed when this case was presented in the hospital conference attended by doctors of different specialties but the opinion of the urologists and various radiologists prevailed. Actually this is a routine practice of hospitals especially tertiary ones where residency training and medical students are around. Problematic and difficult cases are discussed and researches are done not only for the sake of the patient but for further learning purposes. More interesting cases are even presented in conferences conducted in other medical centers attended by other specialists with different or similar experiences.
As a rule prostatic cancer is treatable at an early stage. This is the experience of another lawyer who had a similar case. He was treated in a medical center in Taguig, Rizal and after he was pronounced to have fully recovered, he went abroad allegedly to visit his children to celebrate and enjoy his recovery but actually to confirm his recovery. He even brought home piles of books several of which he shared with me after a lengthy introduction of their contents and of course of his miraculous recovery!
Another interesting alleged prostatic metastatic case is a very successful businessman who routinely walks around Burnham Lake practically every morning before he starts his day. He is also very careful with his diet that no extra bulging fat could be noticed in his well kept frame. He never manifested any urinary complaints despite his seventh decade of existence. Just like the above lawyer, he suddenly experienced difficulty of breathing which made his children rush him to the hospital. His chest x – ray revealed massive metastatic lesions which when correlated with his prostatic examinations came from his asymptomatic male organ.
Actually some surgical practitioners claim that the bone is a more common site of prostatic metastasis. We are not aware of the statistics but we encountered a number of patients in the hospital where we practice who unfortunately suffered the bony metastasis. I could recall at least two of them were admitted because of collapsed vertebrae compressing the spinal cord causing paralysis of their lower extremities. Their diagnoses were confirmed by a biopsy.
Prostatic metastases are very insidious. It may be applicable to other cancer lesions also but it is best to be aware especially the males entering their retiring age. The blood test for the prostatic malignancy is the Prostate Specific Antigen or PSA. It is suggested however that a urologist should be consulted for its interpretation for a rectal examination may be required. Fingers of urologists after a thousand or more rectal examinations could easily determine if one has a normal or abnormal prostate and whether it is benign or malignant. Routine examinations are recommended for males reaching 45 years of age or more. In individuals who have a family history of the Ca, examination at an earlier age or at 40 years is advised. This should be done every two years. Early stages of Ca have greater chances of successful treatment. With metastasis palliative treatment could only be done. Of course some may disagree especially those who profess to be learned medically with lots of successful experience in treating cancer. We congratulate them for their success! **

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