Prostate Cancer with Extension to Vertebral Bodies

Prostate cancer is a unique pathology of man, if not treated and diagnosed in time would lead to serious consequences and even death.

For a long time campaigns have been created in order to raise awareness and make prostate examination part of the routine of studies in men over 45 years because as age increases the risks, however despite the campaigns and recommendations of specialists in the area, men do not resort to this type of medical check-ups resulting in the diagnosis of this disease late, which makes it very difficult to control the disease as it should be.

Physiologically the prostate with the passing of the years experiences a growth that is considered normal and is called Benign Prostatic Hyperplasia, the normal size in adulthood the prostate have an estimated weight of 20 gr and as the years go by can reach a weight of 30 gr and be considered non-pathological.

It is estimated that prostate cancer represents the second cause of death in men, that the risk increases with age and is accentuated if there is a family history and black race has a higher incidence.

^{Prostate Cancer Awareness Prostate Cancer Blue Ribbon. CC0 Public Domain maxpixel}

Now let's talk anatomically about the prostate

This small internal organ is considered an exocrine gland because it is in charge of elaborating and releasing chemical substances exclusive to man, essential in ejaculation.

The structure is located in the pelvis behind the pubis, below the bladder and in front of the rectum, surrounding the initial portion of the urethra, which is why, at the time of dividing the urethra for anatomical study, the first portion is called the prostatic urethra.

Due to its location is that all these specific symptoms arise that tells us that there is a prostatic growth, as it increases in size generates a kind of compression to the urethra. Classically it has been described that the prostate has the form of chestnut, nut of fibroelastic consistency, and contained by a capsule that surrounds and delimits it.

Its function is to contribute in the elaboration of the semen, since it is in charge of elaborating the liquid that nourishes and protects the spermatozoids, therefore it is part of the masculine reproductive system.

^{Male reproductive system. CC BY-SA 3.0}

What is prostate cancer?

This type of neoplasia is hormone-dependent, with physiopathological basis in androgens, this malignant growth may be the result of uncontrolled growth by the cells of the prostate that suffer certain changes with aggressive behavior to invade and infiltrate the organ.

Most of the time or in early stages the neoplastic lesion can be only local and go unnoticed for a long time, even up to an estimated 10 years, until it has the ability to spread to other organs and tissue causing metastatic lesions, being the most frequent bone lesions in the first place followed by ganglion, brain, lung and others.

The prostate is made up of several groups of cells, which are usually the triggers of these neoplastic processes product of uncontrolled growth. The most affected cells are those covered by this gland and are called acinar adenocarcinomas, representing 90% of cases and are slow-growing.

There are also other types of neoplasms:

Ductal adenocarcinoma, located in the cells lining the ducts of this gland, tend to grow much faster.

Cancer of transitional cells, squamous and small cells, the latter are of rare presentation, but with a high degree of infiltration and malignancy.

Physiopathology

Under normal conditions the prostate begins to develop before birth and this growth increases with age, mediated by hormones called androgens, where the main involved is testosterone.

Where these hormones play an essential role in both the growth, maintenance and execution of gland functions, it also has a permissive role in prostatic carcinogenesis.

Our organism is in constant replacement of aged or dead cells by young cells, in order to preserve the vitality and functionality of tissues and organs. This replacement of cells needs a balance, a mechanism that controls it and guides it to exercise this function. When this equilibrium is fractured, an uncontrolled cell reproduction and division is generated, which leads to an exaggerated and abnormal cell proliferation that, as a final result, will be a tumour.

Therefore, if these cells, which have the capacity to be malignant, can reach and infiltrate tissues or organs, in this case the prostate, what we call prostate cancer would form. However, this physiopathological mechanism would also explain other types of neoplasms which are the product of an uncontrolled and aberrant growth of cells with malignant characteristics.

On the other hand, if these cells that infiltrate the prostate have the ability to move or spread or other areas is what is known as metastasis.

Some of the most frequent symptoms:

In early beginnings, it can go unnoticed for a long time, and only be detected as a casual finding or during routine examination, however, there are other cases, more than 70% that present obstructive urinary clinic secondary to a neoplastic process at the level of the prostate as a result of its growth and these are;

Urination push, post urination drip, urinary urgency, and even involuntary loss of urine.

Nicturia, dysuria, decreased urinary stream, retention of urine and even sometimes formation of bladder balloon.

Sensation of not emptying the bladder completely.

Erectile dysfunction, pain during ejaculation, decrease in ejaculated semen and even bleeding during ejaculation.

How we diagnose prostate cancer?

The diagnosis is made using a screening technique, which is used to detect breast cancer. In this case for the man it would be the rectal exam, where it allows the doctor through the touch to know the characteristics of the prostate, size and consistency.

The determination of the prostate antigen, PSA T and L which is considered a specific tumor marker, which is elevated most of the time in prostate neoplastic processes.

Transrectal ultrasound, which allows the visualization of the prostate and the identification of malignant lesions.

The prostate biopsy, which histologically will give us a diagnosis based on the characteristics of the cells and is considered the standard goal with a sensitivity and specificity of 100%.

Prostate cancer metastasis lesions

It is calculated that the neoplastic lesions that invade the seminal vesicles tend to have a higher rate of dissemination to other structures, the infiltration of organs close to the prostate such as the rectum is infrequent in relation to the bladder.

In advanced stages of this neoplasm, it is affected what are the ganglion chains most often the intra-abdominal ganglia in these cases.

Bone metastases involve the bones of the head, chest, and dorsal lumbar spine. Lung, liver and adrenal glands are less affected.

Next I will present the real clinical case of this pathology

In my office comes a 52 year old man, where he commented that he had never suffered from any specific disease, throughout his life was totally healthy. But he manifested lumbar pain for about 3 weeks, which during the course of the days was intensifying. Some studies were performed to identify any injury and the results were negative. A week later he returned to my office again with more intense pain, but this time with loss of muscle strength of the lower limbs, which finally becomes total, without bladder and rectal sphincter control, so he goes to the doctor's office.

It denies important personal antecedents. Only refers paternal grandfather with prostate cancer. Denies tobacco habits, only occasional Enólicos, and coffee one cup a day.

Weight loss of 9 kg in 6 months, without presenting fever or night sweats, tremors, arthralgia, myalgia, manifestations of bleeding, dyspnea and palpitations.

Refers previous daily evacuation pattern, no mucus, no blood. Voiding pattern; refers to decreased voiding, post voiding drip and sensation of incomplete emptying of the bladder.

The patient who enters in stable clinical conditions, where the positive thing to the physical examination is the conscious neurological commitment oriented in time, space and person, coherent and fluid language, without alteration of cranial pairs, with paraparesis of lower limbs FM 0/V hyporreflexic, sensory level T9, without stiffness of nape without meningeal signs. Prostate touch is performed, during the exploration showing enlarged prostate size, indura, irregular edges of stone consistency, estimated weight 35 gr.

In laboratory tests hematologically in normal ranges, hemoglobin 13 and leukocytes in 5,600 with 68% segmented. Indirect markers only elevated LDH 690, alkaline phosphatase 367, uric acid 6.2 rest of hepatic and renal functionalism within normal values.

In view of finding to the physical examination and of laboratory of requests in rest of complementary studies, between which it includes computed axial tomography of simple dorsal-lumbar column, observing the following thing:

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Images show fracture of vertebral bodies T8-T9, change of intensity in body T7,T6,T5 and T10. Also in the body of the sternum, pelvis and femur, and at the level of L1-L2-L3 suggestive of metastatic lesions.

It is also evident in the images of lesions at T8-T9 level, of soft tissues that compresses the medullary canal, but does not section it.

There is an enlarged prostate with irregular borders that impresses the rectum and bladder.

In view of the above, a sample of prostate biopsy is taken while awaiting results. Decompression of the medullary canal is performed, and biopsy of soft tissue lesion at T8-T9 level is taken, awaiting results.

Bone metastases at dorsal-lumbar spine level

80% of bone metastasis lesions come primarily from a primary cancer of lung, breast, prostate, thyroid and kidney.

This type of patient who develops these lesions, are in advanced stages of their disease, and are usually considered to be catastrophic lesions, which diminishes the quality of life, and their prognosis is bleak.

Depending on the location of the lesion in the spine, it will express the patient's clinical, muscular, sensitive, and even the control of both bladder and rectal sphincter, all together when they are involved called Medullary Syndrome, which can present as complete and incomplete.

The spinal column is considered the pillar that provides stability to the body, despite being such a refined structure is capable of supporting the body, and also through it runs the spinal cord and a series of nerve endings that allow the movement of the human body.

When this important structure is compromised by some neoplastic process, the patient's quality of life and prognosis are unfavorable. This is the reason why we insist on a check-up from the age of 45 in the case of prostate cancer, in order to avoid these severe complications that lead to bedding, functional limitation and even without risk of infectious processes such as skin and soft tissue infections (decubitus ulcers), respiratory infections due to mismanagement of bronchial secretions, and urinary infections due to the use of permanent catheterization in some cases.

Currently the patient is undergoing symptomatic treatment. If you have any questions about the subject you can leave your opinion in the comments.

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