Clinical Cases

Cancer of the Prostate in a Man of 74

Dr. Vitan Gosain presents a case of prostate cancer in a man of 74. Indifferent to family and work, absent minded, domineering, desires company, averse to being alone, chilly, thirstless, were among the symptoms that led to the simillimum.

This is a case of adenocarcinoma of the prostate, in a patient of 74 years, living in Punjab. I happened to see this case in September 2018. He had developed testicular cancer and had undergone bilateral orchidectomy in September.

By that time the cancer had spread to the prostate and spine. When this patient visited me he was in a wheelchair and his prostate specific antigen was 378ng/ml (normal <4ng/ml), which had been 2220ng/ml before the orchidectomy. PSA is present in small quantities in the serum of men with healthy prostates, but is often elevated in the presence of prostate cancer or other prostate disorders. PSA is not a unique indicator of prostate cancer, but may also detect prostatitis or benign prostatic hyperplasia.

He was a known case of diabetes mellitus and hypertension. The patient had undergone PTCA in 2011. He did not undergo any chemotherapy or radiotherapy because of his cardiac complaint.

TRUS guided prostate biopsy reports were as follows:

  • Acinar adenocarcinoma with focal neuroendocrine differentiation.
  • Gleason’s score – 9(4+5)
  • WHO grade group – 5

There was evidence of perineural invasion and the synaptophysin (marker protein for neuroendocrine cells and neoplasms) was focally positive.

The CT scan of the abdomen revealed:

  • Malignant prostatic mass with extracapsular extension on right side with pelvic lymphadenopathy and extensive bony metastasis. (REPORTS ATTACHED)
  • Small left inguinal hernia with herniation of abdominal fat.

The LFT revealed raised serum alkaline phosphatase (186U/L, normal- 30 to 120) which might have been a result of bone metastasis.

The patient presented with:

  1. Profound generalised bone pains especially in right leg and thoraco-lumbar spine.
  2. Sensation of tingling and heaviness in the right leg.
  3. Excessive urging to urinate with scanty and intermittent urinary discharge.
  4. Dryness of the throat.
  5. Muscle wasting and loss of muscle power in both legs.

PHYSICAL GENERALS

Appetite- extremely poor.

Thermal reaction – Chilly

Thirst – Thirstless

Desires- Sweets

Stools- constipated, ineffectual urging for stools.

Sweat- back

Urine- excessive urging and scanty discharge; intermittent stream of urine.

Sleep- disturbed on account of the terrible bone pains.

PATIENT AS A PERSON (MAN IN DISEASE)

  • Patient had become completely indolent and was averse to any mental or physical labour.
  • Indifferent to family and work.
  • Of late has become absent minded.
  • Domineering
  • Desires company, averse to being alone.

ANAMNESIS

Prior to the development of the testicular cancer the patient had lost his son in an accident. However, he did not cry much in spite of the terrible loss that he had to face. He used to weep only when he was alone. The patient had become emotionally numb.

PRESCRIPTION

The patient was prescribed CONIUM MACULATUM in ascending LM potencies.

Latest PSA – 155ng/ml

Last alkaline phosphatase level – 88U/ml (normal limits)

The patient no longer needs a wheelchair and now walks for an hour daily and is having no urinary discomfort as well. His appetite has improved. He is no longer constipated. There are no bone pains whatsoever. He has also gained some muscle mass.

COMMENTS

  • APHORISM 14 (THE HOMOEOPATHIC PROGNOSIS)

“There is, in the interior of man, nothing morbid that is curable and no invisible morbid alteration that is curable which does not make itself known to the accurately observing physicians by means of morbid signs and symptoms – an arrangement in perfect conformity with the infinite goodness of the all-wise Preserver of human life.”

  • LECTURES ON HOMOEOPATHIC PHILOSOPHY- J.T. KENT

“The physician who applies the single remedy in potentised form under the Law Of Cure any length of time will easily be convinced that there is no other way of palliation that holds out any permanent hope for the patient……In consumption and cancer and wasting sickness the remedy that is most similar to the painful groups of symptoms will ever give the most relief and it is a forlorn hope that tempts its abandonment.”

  • KEYNOTES AND CHARACTERISTICS – H.C. ALLEN
  1. Debility of old people; complaints caused by a blow or fall; cancerous and scrofulous persons with enlarged glands; rigid fibre.
  2. No inclination for business or study; indolent, indifferent, takes no interest in anything.
  3. Memory weak, unable to sustain any mental effort.
  4.  Morose; easily vexed; domineering, quarrelsome, scolds, will not bear contradiction (Aur); excitement of any kind causes mental depression.
  5. Dreads being alone, yet avoids society (Kali-c, Lyc).
  6. Glandular induration of stony hardness; of mammae and testicles in persons of cancerous tendency…
  7. Great difficulty in voiding urine; flow intermits, then flows again; prostatic or uterine affections.
  • A SYNOPTIC KEY TO THE MATERIA MEDICA- C.M. BOGER

Ø REGION- GLANDS; Sexual organs

Ø DEBILITY

Ø New growths

Ø Slow

Ø …fears being alone

Ø Testes enlarged

Ø Urine stops and starts.

Ø GLANDS HARDEN AND GET SORE.

Ø Hebetude

  • KENT REPERTORY
  1. MIND, ABSENT MINDED
  2. MIND, BUSINESS, averse to
  3. MIND,COMPANY, desire for
  4. MIND, DICTATORIAL
  5. MIND, GRIEF, ailments from
  6. MIND, INDIFFERENCE, apathy
  7. MIND, WEEPING, alone when
  • BOGER BOENNINGHAUSEN CHARACTERISTICS AND REPERTORY
  1. PROSTATE GLAND, Enlarged, swelled
  2. URINE, MICTURITION, interrupted
  3. GENITALIA, MALE ORGANS, In general
  4. GENITALIA, TESTES, Induration
  5. AGGRAVATION AND AMELIORATION IN GENERAL, Alone, when agg

About the author

Vitan Gosain

Vitan Gosain received his BHMS one year ago from Nehru Homoeopathic Medical College (Delhi University). Now there are two homeopaths in his family, as his father Dr. Bimal Gosain is also a homoeopathic physician, practicing for the last 30 years. Vitan has been sitting in on cases with his father regularly for the last five years. He also learned from Dr. L.M. Khan of Calcutta.

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