Analysis of of Patient Has Prostatic Cancer that Affects Different Organs - Case Study Example

Prostatic Cancer and Prostatic Cancer Patient’s History and symptoms The patient is a 59 year old man who is experiencing urinary retention and severe back pain. He has not presented any blood loss in the urine, however, after examination; he has shown a rash and some bruising. The patient has recent history of urinary retention but has been well until when his doctor saw the need of him to visit the hospital. This is a clear indication that this condition was slowly advancing to its present state. Mutation in gene CHEK2 CHEK2 gene is crucial for making protein checkpoint kinase 2 (CHK2). This protein helps in suppressing tumors; this means that it regulates the cell division. Analysis of the tests conducted on the patient shows the presence of gene CHEK2, which indicated prostate cancer. This mutation can contribute to the development of prostate cancer and, therefore, is useful for early diagnosis of prostate cancer. Background on Prostate Cancer Prostate cancer is ranked as the second leading type of cancer that is diagnosed among men around the world who are over 50 years old. Thousands of men die every year because of this disease. Even though there has been a lot of research, there has not been an exact cause and treatment of the disease (Ellsworth, 2009, pp. 12). Scientists believe that prostate cancer develops slowly over a period of many years because of a gradual change in the cells. An egg-sized glad that is located in male reproductive system is responsible for this cancer. Prostate cancer starts when once normal cells in the prostate gland start to transform into cancer cells. The reason resulting to this is not exactly known. However, some scientists believe that the diet has a lot to do with the growth of tumour. It is noted that men who do not consume a lot of fish oil have a higher risk of getting prostate cancer than those who consume high levels of fish oils. It has also been noted that dietary fat can lead to this disease. Dietary fats can change the production level of growth factors and sex hormones, his can in turn increase the risk of prostate cancer. In addition, people who have diets that are high in soy, vitamins D and E, green tea, and selenium have a lower risk of getting prostate cancer. Genetics is also a crucial factor in determining people who have the risk of getting the disease. People who have a first degree relative, such as a brother or father, or a second-degree relative, such as an uncle and grandfather, are at a higher risk. Age is the most crucial risk factor for getting prostate cancer. Even though the disease is seen in men of all aged, it is reported that over 80% of prostate cancer occurs in men who are over 65 years. Prostate cancer has four stages of development. In the first stage, the tumour is hardly detectable and is isolated in the prostate gland. During the next stage, the tumour is still isolated but noticeable (Hennenfent, 2005, pp.49). Afterwards, the immediate surrounding organs get affected by the cancerous cells. In the final stage, the cancerous cells invade the lymph system and the blood, and to other parts of the body (Tewari, 2013, pp.289). Thesis of conducting tests Preliminary analysis shows that the patient has stage one of prostate cancer. This is because he presents signs of the condition because he has urinary retention and back pain. Laboratory Findings Prostate cancer is a condition that usually develops slowly over a number of years and often affects the urethra. Some obvious conditions include straining while urinating, increase in the need to urinate, experiencing, and back, hips, and chest pains. Other conditions are numbness or weakness in the feet or legs, and the feeling that the bladder is not empty. Prostate cancer usually develops among men who are over 50 years of age. According to the preliminary clinical information provided about the patient, there a high likelihood that the patient has Adenocarcinoma (primary prostate cancer). This condition may have affected the liver and led to the blockage in the urinary tract resulting in acute renal failure. The urinary tract infection (UTI) and kidney failure are likely to be the reason the patient is experiencing the severe back pain. This can also explain why the patient is experiencing urinary retention and severe back pain. Further laboratory tests conducted on the patient give more information concerning his condition. The PSA test is useful in primarily screening for prostate cancer in patients. This looks at the level of Prostate-specific antigen (PSA) in the patient’s blood. PSA is produced by the prostate and is usually found in the semen. It is a protein that is produced in the prostate gland and which keeps the semen in liquid form. Looking at the tests conducted on the patient, he has a PSA level of 55 ng/ml which is more than the normal value of 4.0 ng/ml or less. This level shows a high probability of prostate cancer. This level indicate abnormalities in the prostate gland that may be malignant or benign (Benign prostatic hyperplasic or BPH). This test can be used to screen the prostate gland in order to identify any potential problem and as a monitoring test during prostate cancer therapy. The levels of PSA usually increase in men who have prostate cancer. However, this is not a perfect test for prostate cancer because it may give false-negative and false-positive tests. This is especially crucial because PSA levels can increase as the age advances and when a patient has benign condition. It is also noted that conditions like the inflamed or an enlarged prostate can lead to increase in PSA levels. Urinary tract infection which can inflame and irritate the prostate cells also result in an increase is PSA. Medical procedures that cause traumatic experiences interfere with the surroundings of the prostate gland can also increase the PSA. For example, when a catheter is placed in a patient’s bladder or taking a biopsy. A more reliable test of prostate cancer is the microscopic examination of the patient’s peripheral blood samples. The aim of examining te peripheral blood film was to look at the physical characteristics of the platelets, red cells, and the white cells under the microscope. This aims at checking if there are abnormal cells or parasites in the blood. Results from this test indicated the presence of red cell rouleau. There was a possibility of moderate leukocytosis but, there were clear features of leukoerythroblastic features, including promyelocytes, myelocytes, and occasional blast cells. There were no signs of Nucleated Red Blood Cells present, but they may be in small numbers. This possibility is high because the patient is losing red blood cells when urinating. There is no evidence of pronounced thrombocytopenia. The possibility of low red blood cells count presents the risk of anaemia which is most likely caused by renal failure. The patient may be experiencing blood loss in the urine (haematuria) because of localized prostate, kidney, or bladder cancer. Haematuria is usually as a result of the internal growth of the metastatic deposits on the walls of the bladder or growth of the prostate in the urethra. Another test for prostate cancer is the histology report. This report has shown an intraductal carcinoma, which are solid growth of malignant cells with marked nuclear atypia. This is a high indication that the patient may have intraductal carcinoma of the prostate. This is closely related with high-volume and high-grade invasive prostate cancer. The possibility renal failure is evident in changes in the urea level of the patient. Tests performed on for diagnosis of uremia show an increase in the urea level of 18 mmol as compared to the reference range of 3.6-7.1. This is an indication that the patient has most likely developed renal failure. Uremia also indicates that the patient is possibly having kidney failure or impairment. This means that the kidneys are not able to filter nitrogen wastes properly resulting in high levels of nitrogen wastes in the bloodstream. This test is crucial because if the condition continues, permanent damage will be done to the kidneys. This is a complication that is usually associated with prostate cancer because when the prostate overgrows, it usually obstructs the urethra and in turn impend urine flow. This in turn leads to an increase in the hydrostatic pressure, which contests the glomerular filtration rate. This situation ultimately results in renal failure. This can explain the severe back pain and urinary retention experienced by the patient. When the urinary track is blocked, the result is stagnated urine that can cause swelling and other damages to the kidneys. The possible causes of urinary tract abstraction can be kidney and bladder stones or cancer that has spread to the bladder, kidney, or colon. This situation presents a high risk of urinary tract infection (UTI). This can affect any part of the urinary tract including the bladder, urethra, kidney, or any other close structures (Abuelo, 1995, pp.13). The main agent that contributed to this from the test done on the patient’s urine culture is p.mirabilis. Proteus mirabilis is known a gram-negative enteric bacterium that causes infections in the urinary track in people who have structural or functional abnormalities in their urinary track. It is possible that the enlargement of the prostate has resulted in urethra obstruction, which has in turn created and environment for p.mirabilis. This might have released enzyme urease that caused stones in the kidney. Another possibility is that enlarged prostate cause urea to stay for a long time in the bladder. The prostate may have joined to form crystal which hardened to form bladder stones or calculi. The symptoms include back pain, which further explains the severe pain that the patient is experiencing. p.mirabilis can develop kidney, bladder, and bacteria stones. Another clear symptom of UTI infection of the bladder and urethra seen in the patient is the excretion of bloody urine. Further tests are crucial to getting crucial information about the kidneys (Herzog, 2012, pp.326). Healthy kidneys can filter creatinine and other wastes from the blood. The laboratory tests conducted shows an increase in the creatinine levels in the patient’s blood to 79.35 ml/min compared to the reference range used of (70-75ml/min). This increase indicates that there is a condition or disease affecting the kidney functions; most likely it is a sign of prostate disease. This can further support the assumption of stones in the kidney as a result of urethra obstruction. In addition to this, there is a high possibility that the tumour has metastasized to the liver, which can be explained by the increase in the alkaline phosphate (ALP) and the bilirubin levels. Alkaline phosphate is found in the liver (Wallach, 2007, pp.229). ALP tests aim at determining the amount of alkaline phosphate enzyme in the bloodstream. ALP is produced more in the liver than in bones and other organs (Schrier, 2007, pp. 2460). However, in case of liver disease, the level of ALP synthesis increases because of elevated concentrations of the tissue bile salt in cholestasis. The normal levels are between 30-90 IU/L but tests show levels of 112 IU/L, which is an abnormal level. This is a clear indication of liver disorder or disease. The results from the tests are even higher than the normal levels ejected from a normal adult, which is between 25 and 100 IU/L. ALP is considered to be a relatively sensitive screening test for liver metastatic tumour. However, ALP can also be increased when the patient has bone disorders like metastases of the bone and patient’s disease. It is therefore, crucial to rule this disorder out. Further laboratory tests on the patient seem to indicate the possibility of increased ALP production in the liver. As indicated above, the patient also has a high level of bilirubin which is at 96.9 umol/L as compared to the a measure of up to 20 umol/L expected. Bilirubin test aims at checking the levels of bilirubin in the patient’s blood (Wallach, 2007, pp. 273). Lower levels of bilirubin in patients are usually not a concern. The high levels of bilirubin indicate liver disease (Rodak, 2007, pp.279). This means that the liver is not able to efficiently remove bilirubin because of liver disease or blockage of the bile ducts or that he has jaundice. Jaundice is a condition where too much bilirubin is being produced, especially, because of haemolysis. This condition can also indicate that the patient has haemolysis, which is the increase rate of red blood cells destruction. However, this can also be a perfect indicator of prostatic cancer because higher levels can also be caused by other problems. A good example is the Gilbert’s syndrome, which is the deficiency in the enzyme that helps the body to break down bilirubin. Medications and other foods can also affect te results on these levels. Additional lab finding that support the possibility of liver disorder or disease is the prothrombin time (PT) test conducted on the patient. This test measured the time it takes for the plasma to clot. From the test conducted, it took 45 seconds for the plasma to clot which is higher than the expected time of 20 seconds. Partial thromboplastin time (PTT) test also shows possible abnormalities in the liver function. This test shows the time it takes for the blood to clot. In this case, it shows that it takes 120 seconds for the blood to clot as compared to the control time of 35 seconds. This time is even higher than the normal time of between 25 to 35 seconds and supports the abnormal condition in the patient’s liver. The prothrombin time is used to measure factors VII, X, V, fibrinogen, and prothrombin. The partial thromboplastin time (PTT) is used to measure factors V, VII, IX, X, XI, XII, fibrinogen, and prothrombin. All factors involved in coagulation are synthesized by the liver except the factor VII. For this reason, a defect in the liver is reflected in how the clotting factors are performing (Beck, 2009, pp.43). This can explain why the patient has a rash and some bruising, and low platelets count. The thrombin time (TT) or the thrombin clotting time measure the time taken for a clot to form in plasma of blood that contains an anticoagulant. The thrombin time of this patient is 50 seconds, which is longer than the expected time of 15 seconds. This is an indication of an abnormality as a result of afibrinogenemia. This further explains the defect in the liver that results in an increase in fibrinogen. Prolonged coagulation period from the screening results indicate that there is the presence of disseminated intravascular coagulation (DIC) which is also known as the consumptive coagulopathy. The dysfunctional liver interrupts the normal coagulation level, resulting in DIC. Prostate cancer is associated with DIC. This tumour can release tissue enzymes or necrotic tissue in the general circulation of the body, thus activating the coagulation flow. DIC is a situation where the blood starts to coagulate in the patient’s whole body. This leads to a depletion in the coagulation factors and the platelets, and also leads to an increased risk of haemorrhage. Conclusion Prostate cancer is one of the leading cause of death among men. Diagnosis of prostate cancer usually involves performing a Digital Rectal Examination (DRE) where a lubricated and gloved hand is inserted into the patient’s rectum to feel the shape and the size of the prostate. After the second stage of development, the cancer is felt as a bump. Other methods include testing the blood Prostate Specific Antigen (PSA) level. Increase in PSA level indicated the presence of cancer. From the test conducted, the patient seems to have an advanced level of prostate cancer that may have affected other parts of the body, including the kidneys and the liver. This may have resulted in many complications like UTI and renal failure (Lippincott, 2008, pp.105). Treatment of this condition includes; watchful waiting, radiation therapy, hormone manipulation, and surgery (Slawson, 2007, pp. 479). The type of treatment chosen depends on stage and grade of growth of the tumour, and the age and health of the patient. For example, patients who are over 50 years old like this patient have a better chance of being cured when using watchful waiting because of health complications. The best method depends on the age and the health of the patient. Considering all the option, watchful waiting is the most recommended method for this patient because he is over 50 years old, and it is possible that he has a health problem. However, before this method is applied, further tests need to be performed to make sure that the tumour is not expected to grow too fast. Surgery, in particular, radical prostatectomy, can be used by removing the prostate, seminal vesicles, ampillae of the vas deferens. Radiation therapy treatment can also be used where a small external beam of radiation is concentrated on the tumour so as to shrink and kill it. The renal failure can be treated using different methods like kidney implants, haemodialysis, and peritoneal dialysis (Ramon, 2007, pp.72). DIC can be treated in various ways depending on its cause, such as, supportive therapy, anticoagulants therapy, and antibiotics. Further, possible laboratory tests need to be done to confirm the diagnosis made and to exclude other possible complications (Ankerst, 2009, pp. 309). From the results of the laboratory tests conducted, the bilirubin level id 96.9 umol/L as compared to the a measure of up to 20 umol/L expected. This is most likely cause by liver disease, however, further tests need to be done to determine this likelihood. Liver blood tests are the commonly performed tests to determine the liver function. Measurement tests on liver enzymes such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT) will crucial in determining if there is liver disease, injury or damage. Normal levels of ALT are between 7 and 56 units per litter and AST 10 to 40 units per litter. Severe elevation of these enzymes indicates damage to the liver. A biopsy also needs to be done to identify if cancer has spread to other parts of the body. This is by performing the lymph node biopsy to determine if the cancer has spread to the lymphatic system. This process involves removing a small amount of tissue from the patient and examining it under the microscope. This method is considered to be one of the most definite diagnosis of cancer. From the tests conducted, there is an increase in the alkaline phosphate. The results showed an elevation of alkaline phosphate from the normal level of between 30-90 IU/L to levels of 112 IU/L, which is an abnormal level. This is a clear indication of liver disorder (Weatherby, 2002, pp.121). The results from the tests are even higher than the normal levels from a normal adult, which is between 25 and 100 IU/L. To determine the sources of the increase in ALP, more tests need to be conducted. This is crucial because this can be as a result of the bone and the liver disease. However, the ALP that is produced in the liver is usually different and can be distinguished using electrophoresis separation (Fischbach, 2009, pp. 415). Further tests to confirm renal failure can include measurement of ECG to show any changes resulting from hyperkalaemia, plasma creatinine, and plasma HCO3 ultrasound that will show obstruction. Bibliography Abuelo, J. G. (1995). Renal failure: Diagnosis & treatment. Dordrecht [u.a.: Kluwer Academic Publ. Pp. 13. Ankerst, D. P., Tangen, C. M., & Thompson, I. M. (2009). Prostate cancer screening. New York, NY: Humana Press. Pp. 309. Beck, N. (2009). Diagnostic hematology. London: Springer. Pp. 43. Ellsworth, P. (2009). 100 questions & answers about prostate cancer. Sudbury, Mass: Jones and Bartlett. Pp. 12. Fischbach, F. T., & Dunning, M. B. (2009). A manual of laboratory and diagnostic tests. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Pp. 415. Hennenfent, B. (2005). Surviving prostate cancer without surgery. 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