By Mark C. Scholz, MD // Prostate Oncology Specialists
Since prostate cancer is predominantly a slow growing and asymptomatic disease, emergencies directly caused by prostate cancer are relatively rare. But there are a few conditions that can arise and it is good to be aware of them. Dr. Scholz highlights a few of these emergency conditions.
All jobs have their pros and cons. Good pay versus bad hours; tough bosses versus a nice work environment; and so on. One thing I really like about specializing in prostate cancer is that emergencies are very rare. My job requires making important decisions about people’s health, but the slow pace of prostate cancer gives plenty of time to think and reflect about the advice I render. What I don’t like about emergencies is that they demand immediate action. People get rushed by the urgency of the situation, thinking gets clouded and mistakes are made.* In the world of surgery or emergency medicine, for example, mistakes are common. When doctors make mistakes, people suffer.
Managing men with prostate cancer certainly presents many emotional and intellectual challenges. Time pressure, thankfully, is rarely the issue. Recently, however, I got a call and was reminded about the exception to the rule, an emergency that everyone with metastatic prostate cancer needs to know about. A support group leader in Phoenix called me for advice about a mysterious situation faced by a man in his support group. Apparently, this individual had developed unexplained weakness in his legs for the last six weeks. He was also having trouble controlling his urinary function. He was concerned. The doctors seemed mystified as to the cause. He wanted to know if I had any ideas about what might be going on.
Even before he finished speaking a hopeless feeling started to rise in me. He was describing the common symptoms of spinal cord compression. Pressure from progressive cancer in the spine was pushing on the spinal cord choking off its blood supply. Without immediate treatment paralysis usually becomes permanent. He did say a neurologist had been consulted the preceding day though he had not heard yet what the doctor was recommending. I assured him that any competent neurologist would know exactly what to do. Since I did not have all the medical details I refrained from telling him that his friend's symptoms were likely to be irreversible.
SPINAL CORD COMPRESSION
Spinal cord compression is a disaster. However, knowledgeable patients and doctors who act quickly can prevent it. What are the symptoms that men with metastatic cancer should be aware of?
New, sudden onset or sharply increased intensity of pain in the spine
New, sudden onset of weakness or numbness in the legs
New, sudden loss of urinary control or bowel control
The “suddenness” is related to the progressively enlarging tumor in the spine pressing on the spinal cord, “pinching” the cord against the bony wall of the spinal canal, cutting off the blood supply. Without blood, the cord will die. All nervous control of all the functions of the body below the level of compression will be lost.
Since cord compression is a medical emergency, men with metastatic disease who suddenly develop a new persistent pain in the spine should contact their doctors immediately or go to the emergency room. Whether or not the spine pain is due to cord compression can be determined by performing an MRI scan. If cord compression is confirmed, treatment with high dose cortisone is begun and the tumor is treated with emergency radiation or surgery. If cord compression is diagnosed and treated in a timely fashion the symptoms are 100% reversible.
CHEMOTHERAPY AND THE IMMUNE SYSTEM
In the interest of completeness, let me briefly relate the only other prostate-cancer-related emergency I am aware of. This situation only relates to men who are taking chemotherapy. Chemotherapy causes transient, cyclical suppression of the immune system. A patient’s vulnerable period occurs about one week after the infusion is administered. If men develop a fever during this time period, they need a CBC blood test to measure their white blood cell count. If the white blood cell count is too low, antibiotics should be started. Otherwise, the infection could become life-threatening.
I find the emotions of anxiety and fear unpleasant, clouding thinking and leading to mistakes in judgment. The generally slow-paced world of prostate cancer, therefore suits my personality just fine. A mental alarm needs to go off, however, when men with metastatic disease develop new-onset spine pain or a fever after chemotherapy. If one’s doctor cannot be reached, a trip to the emergency room is needed.
I have also been preparing for many years, ever since the Viagra commercials came out, to intervene on behalf of my patients who develop 4-hour erections. If I ever hear of one, I’ll be sure to write that story as well.