Sex: M, Age: 72 years
Diagnosis: CARCINOMA OF THE PROSTATE
No relevant pathology in the patient’s medical history.
The patient is currently being treated with Citalopram for depression and anxiety from which he suffers periodically.
Blood tests taken after suspending Avodart medication for 6 months, showed a PSA of 8.2 ng/ml ( < 4) and a free PSA of 8.9 ng/ml with ratio of free in total PSA of 9.6 (> 18.0 %).
A transrectal ultrasound of the prostate was performed showing the following prostate size: 37 x 45 x 26 mm, echogenically dishomogeneous due to the presence of hyperechogenic spots, such as the results of a phlogistic process; middle lobe slightly obstructing the opening of the bladder neck; adenomatous thickening found in the central region of the gland, 19 x 18 mm, physiological for the age.
A prostate biopsy was performed with the following histological diagnosis:
1 – Prostate, right lobe 2 – Prostate, left lobe
1 – Prostate bioptic samples at the site of adenocarcinoma, Gleason grade 4 ;
combined grade 7 (4+3).
2 – Minuscule bioptic samples from the prostate insufficient for a histopathology
The patient was examined by a urologist who requested a complete abdominal CT scan and a bone scintigraphy. The results are reported below. While waiting for these results, the patient was treated with Androcur Depot (1 vial immediately and 1 vial after 15 days) and Zoladex (1 vial).
As requested by the urologist, a CT scan of the inferior and superior abdomen, with contrast agent, was performed.
Liver is within the normal range for size, morphology and parenchymal profile.
Signs of hepatic statosis.
No images of focal pathology.
Biliary tree within the normal range.
Spleen with normal size and densitometric characteristics.
Absence of obvious expansive alterations in the pancreatic region.
No relevant images in the adrenal beds.
Kidneys basically within the normal range for size, morphology and parenchymal thickness. Small cystic images at the right inferior lobe level. Elimination of iodized organ-specific contrast agent basically normal and symmetrical.
Thin atheromatous thicknesses and small calcifications in the abdominal aorta wall within the subrenal region with no caliber alterations.
Lymph glandular micronodules in lumboaortic region. Some lymph nodes with dimensions between 7 and 10 mm are found also at the hepatic hilum and celiac tripod level as well as in the intra-aortocaval region. Controls on their development are recommended.
Modest repletion of the bladder with no major endoluminal alterations.
Prostate with size within the high normal limits, and appearing dishomogeneous. Modest irregularities found in the parenchymal profile but with no certain signs of infiltration in the periprostatic structures. Some lymph nodes of reactive appearance are noted bilaterally in the inguinal region”.
A bone scintigraphy taken did not show hyperfixation areas of the osteotrope tracer attributable to repetitive alterations.
Following are the results of the assessments completed in order to evaluate the patient’s clinical condition:
1) Blood exams:
- Glycaemia 102 mg/dl (70 – 105)
- Azotaemia 31 mg/dl (10 – 50)
- Creatinine 1.00 mg/dl (0.6 – 1.20)
- Protein 7.2 g/dl ( 6 – 8)
- Electrophoresis: within normal limits;
2) ECG: sinusal rhythm, atrioventricular conduction within the normal range,
no pathological alterations found.
In reference to what is described above, the patient had another urology exam where a prostatectomy surgery with traditional methods (not a laparoscopy) was recommended to him.
The patient consulted another urologist who instead recommended a cycle of radiotherapy (about 40 applications) along with the following medication treatment:
- Casodex 50 mg 1 capsule a day for 1 year
- Zoladex for about 2 years.
Currently the patient is following this pharmacological treatment.