CLINIC NOTE: This is a new patient who comes self-referred.
HISTORY:
This is an 83-year-old gentleman who has been dealing with prostate
cancer now for multiple years. He initially started having treatment
for this in 1994 when he had external beam radiation for the
prostate
cancer. This was all done at another VA hospital, and he has been
treated there since about 2002-2003 when he came over and
started
getting treatment here. In 2001 he had bilateral
orchiectomy done, and in 2005 here on one of his first trips to the
hematology-oncology, he had chemotherapy done at the VA. The patient now presents to clinic with a PSA of 258.
He comes in
today complaining of left flank pain and with an indwelling Foley
catheter that has been there since May of 2004. It was last changed
on Friday. In
addition he has a 30-pound weight loss in
6
months. No night sweats.
PAST MEDICAL HISTORY:
None.
PAST SURGICAL HISTORY:
Appendectomy, orchiectomy bilaterally.
MEDICATIONS:
Megesterol, Bisacodyl, Bactrim, naproxen, hydrocodone.
DIGITAL RECTAL EXAMINATION: Extremely enlarged, nodular prostate.
ASSESSMENT:
Individual with advanced prostate cancer.
PLAN:
1. We will get him set up here for chemotherapy
treatment and evaluation.
2. We will write him for Casodex and repeat a hydrocodone through
the
VA here.
3. We will schedule the patient for a bone scan and CT scan here.
4. We will follow up the patient in clinic following these studies
to
plan for either palliative or definitive treatment for this patient.
REASON FOR REFERRAL:
Hormone-refractory adenocarcinoma of the prostate and development of
clinical symptoms.
Radiology Report
INDICATION: Prostate cancer, pain in left shoulder
and left pelvis. Had radiation treatment in 1994.
PROCEDURE: Anterior and posterior whole body imaging with spot
imaging of the knees performed 2 hours following intravenous
administration of 29 mCi Tc 99m HDP.
FINDINGS: There are numerous foci of increased activity throughout
the axial and appendicular skeleton. These include multiple foci
within the skull and facial bones, every vertebral body, numerous
bilateral ribs anteriorly and posteriorly, sternum, clavicles,
scapulae, bilateral numerous foci in both sides of the pelvis, worse
in the left ischium and left sacroiliac joint region. There are
numerous foci throughout the right femur and throughout the left
humerus with additional foci in the right humerus, left forearm,
proximal left tibia, and proximal left fibula.
IMPRESSION:
1. WIDESPREAD METASTATIC DISEASE.
