Mr. A. is a 66-year-old man with a 12-year history of prostate cancer. He was initially treated with local radiation and chemotherapy and had an initial positive response. His response was so good that his oncologist scheduled him for annual follow up visits. He remained clear of prostate cancer until 4 years ago when he was diagnosed with metastases to his lumbar and thoracic spine. Radiation and chemotherapy were once again employed but with much less response than he had previously experienced.
Over the last 18 months the lesions have been growing rapidly and invading his spinal canal. At that time he had severe bone pain and lower extremity weakness and burning numbness from spinal cord compression to the point that he could not walk or transfer from bed to a chair independently, and he had bladder impairment requiring a catheter. Due to other medical problems he has been deemed to be a non-surgical candidate by two neurosurgeons despite his loss of bladder control. He had been told that at the rate of spread and growth of the lesions he had 4-5 years to live at most. He was in profound pain and was depressed and hopeless due to his poor prognosis and quality of life. He was on high dose narcotics provided by his oncologist, which had lost their effectiveness at treating the pain and were only successful in that they kept him sedated while his life ebbed by.
Four months ago, at his daughter's insistence he consulted Georgia Pain Physicians, PC. Mr. A. was evaluated and found to have severe bone pain due to erosion of his T9 vertebral body and a small compression fracture. In addition, he had severe nerve damage to his bladder and lower extremities due to spinal cord compression. Initially a small amount of local anesthetic was injected into his spine under X-ray guidance, which completely eliminated his lower extremity pain, and so a temporary catheter with an external pump infusing local anesthetic was initiated. This was highly successful at resolving his lower extremity pain, but did not help his bone pain. A vertebroplasty was then performed at T9, which relieved his bone pain 90% in 12 hours, and it has not returned. Two weeks later the temporary pump was stopped and a permanent pump was implanted. It has now been two months since the treatments were performed and Mr. A. is virtually pain free and is off all narcotic medication. He is alert, has a much-improved quality of life, and is interacting with his family again. He continues to have bladder dysfunction but with the initiation of bladder medications he no longer wears the catheter continually and has been taught to catheterize himself twice per day. He still has difficulty with ambulation but is able to transfer to a chair and bathe independently.
At this point, Mr. A. still only has a life span of 4 years projected, but since his quality of life has improved so much he is looking forward to each new day.