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Abstract: The patient was found to have elevated prostate-specific antigen on physical examination and therefore came to our hospital. After magnetic resonance and puncture biopsy, he was diagnosed with prostate alveolar adenocarcinoma, which is a type of prostate malignancy. The patient was admitted to the hospital and underwent robotic-assisted laparoscopic radical prostatectomy. The surgery went well and the cancer was removed.
Basic information】Male, 68 years old
Disease Type】Prostate alveolar adenocarcinoma
Hospital】The First Affiliated Hospital of Zhejiang University School of Medicine
Date of Consultation】May 2020
Treatment plan】Surgery (robotic-assisted laparoscopic radical prostatectomy) + pelvic floor functional exercise
Treatment Period】7 days of hospitalization, 1 month of postoperative review, and lifelong outpatient follow-up
Results】Surgery went well, the cancer was removed, urinary incontinence disappeared, and the prostate-specific antigen level was normal in the recheck.
I. Initial consultation
The patient was accompanied by his children to our outpatient clinic because of the elevated prostate-specific antigen found during the physical examination. The patient reported “prostate-specific antigen 4.51ng/ml” in the physical examination report 2 months ago, suggesting the need for urological consultation, so he came to our clinic. The patient was diagnosed with “prostatic hyperplasia” at the local hospital, but no medication was administered, and the outpatient clinic disposed of him with “elevated prostate-specific antigen to be investigated” and arranged other tests.
Prostate magnetic resonance imaging (T2-weighted image, white arrows are tumor lesions)
II. Treatment
The patient was given a prostate-specific antigen and prostate MRI examination. The prostate-specific antigen was 4.88 ng/ml and the MRI indicated a 1.3 cm nodule in the right peripheral zone of the prostate, with a PI-RADS score of 3. The patient was then hospitalized and underwent “robotic-assisted laparoscopic radical prostatectomy” for prostate cancer.
III. Treatment results
The surgery went smoothly and the cancer was removed. The patient was able to get out of bed on the first day after surgery and recovered well. The postoperative pathology report was “prostate alveolar adenocarcinoma” and the tumor stage was T2N0M0. The drainage tube was removed 3 days after surgery and the catheter was removed 7 days after surgery, and the patient became incontinent and started pelvic floor function exercise. The patient’s urinary incontinence disappeared and the prostate-specific antigen was 0.001 ng/ml at the outpatient review 1 month after surgery.
IV. Notes
We are glad that the patient’s lesion was removed after treatment and the disease control is stable. However, the patient still needs to pay attention to early activity after surgery. The patient should get out of bed on the first day after surgery, and the diet should be based on fresh and healthy food, and pickled food, waxed food and smoked food should be eaten sparingly or not. After the catheter is removed, pelvic floor functional exercises should be started. The first review 1 month after surgery, then 2-3 months, 2 years after surgery can be changed to 6 months, the review is mainly prostate-specific antigen. The patient should also be reminded to have an annual health checkup.
V. Personal Insights
Prostate malignancy has now become the most common tumor of the urological system, and most patients are found during screening in health checkups, so the middle-aged and elderly population should pay attention to health checkups. For limited lesions, the first choice is radical surgery or radical radiotherapy, and for metastatic lesions, the first choice is endocrine therapy and chemotherapy. The probability of lower limb deep vein thrombosis increases after pelvic surgery, and there is a risk of sudden death due to pulmonary infarction. The purpose of early bed activity is to reduce the occurrence of postoperative lower limb deep vein thrombosis and pulmonary infection and to promote tissue healing. The main postoperative complication of radical surgery is urinary incontinence, but most patients can return to normal within six months with functional pelvic floor exercises.