Neuro-Compressive Prostatic Cancer
Date published: November 21, 2012
Prostate Cancer has taken a fore-front in ‘geriatric-medicine’ since the last four decades, and to the advantage of its sufferers. Among the reasons hereto, are the Physician “simply listening” to the relatively simple diagnostic assays, either with manual detection (rectal examination), Ultrasonography, CAT-Scan, MRI-Imaging, and the chemical assay, such as the determination of the Prostate Specific Antigen (PSA). There emerged euphoria in the same period, propagating that prostate cancer emerging in the seventh decennium didn’t require any relevant oncological attention, and that “it comfortably accompanies the elderly gentleman to his grave, with some other disease being the cause of death”. Studies in the West, in which computer scientists (non-medical) persons participated as patients, led to the conclusion that with or without aggressive mutilating surgical oncological treatment, prostate cancer in the elderly tended not to be the cause of death in men 70 and above. They died with, rather than of the tumour. Treatment of any kind geared towards the tumor did not prolong the life of the patients in any form whatsoever. This stand, HELD FOR DECADES AS A SERMON, seems to be receiving “a-new-look-at”, provoked by an observation by some Neurological Surgeons, whose attention may be called, because of deficits emanating from Neuro-compression! Spinal cord compression may emanate or exhibit as para-paresis (paralysis of both legs), tetra-paresis, involving all four limbs, depending on whether the deficit affects the cervical spinal cord, i.e. at the level of the neck, or lower down, at the level of the thoracic or lumbar (lumbo-sacral) spine. Isolated cranial nerves (nerves exiting directly from the brain) may be affected, leading to such manifestations as double vision, or when the optic nerve may be compressed as a result of infiltration of the optic canal at the base of the skull, or in the optic canal itself, leading to blindness on that “singular eye.” Double vision may lead to the patient not being able to independently get around. The skull base, in some regions thinner than the convexity of the skull, may give in owing to seeding of tumor cells (metastases) and local pressure. Destruction of the skull-base may affect blood-vessels and provoke serious bleeding that might prove lethal, i.e. lead to death. A complexity of cranial nerves-deficits might emanate, adding to the overall discomfort of the patient. Then again, blockage of the Urethra which may be the very first manifestation is a discomfort which frequently precedes detection of prostatic cancer. Medicine has not found any very convenient method of handling this type of urinary-tract obstruction, except the unacceptably uncomfortable passing of a catheter. Low-back pain in the elderly might be provoked by metastatic seeding into the foramina of prostatic cancer. This information, when used properly, might spare the Physician the embarrassment of accompanying a patient complaining of low-back-pain for weeks until obstruction may lead the way.” Frequently, a prostrate tumor may manifest through metastatic growth into the brain parenchyma, or the cortex, and a seizure episode may be the first manifestation. Vertebral bodies are frequently “eaten-up” until they may be compressed longitudinally, causing the destructive compression of the spinal cord, or of the nerve-roots, causing the victim the inability to walk, or being unable to hold something by hand. Defecation and urination may be so compromised that if measures of counteracting this dastardly situation couldn’t be undertaken, death might imminently intervene. This is frequently a cause of death in a patient with prostatic cancer. Causes of prostate cancer, handled in the domain of Urologists until nerve tissue compression, may set in raising the alarm for the Neurosurgeon to abandon “even his Christmas dinner” TO RUSH TO THE WEALTHY EXECUTIVE’S MANSION, hasn’t as of now clearly betrayed any causes, even though Urologists recommending prophylactic measures to avoid such a cancer, recommend daily exercises, just as we doctors in general “tend to say something when we may not know anything.” Occurrence in families continuously over generations keeps being observed. The benign prostatic hypertrophy, which today, even the layman has added to his acronyms as BPH, “is an entirely different kind of soup.” The Urologist who lectured in the Medical School that I attended used to add it (definitely a joke) at the end of every Semester, that if any of his students ever succeeded in finding out why God added the prostate to the male sexual apparatus, such a student owed it to him to come back and tell him. I did not hear whether anybody found out something, and travelled to Mainz, in Germany, to give his boss the news. The boss has been dead since twenty years. Incidences of Prostatic cancer are not on the decline. The reverse seems to be the case. Routine of frequent rectal/digital examination (ONCE YEARLY) after age 45 years, PSA sampling and Ultra-sonography screening on a yearly basis, and there would be nothing against MRI-screening, when affordable, should be seen as beneficial in detecting early enough, prostate cancer. The issue of the BPH is there for the Urologists to advise on.
Kofi Dankyi Beeko, MD
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