by Priya Jadhav
On a consequential six-hour-long surgery, Nanavati Super Specialty Hospital doctors remove patient’s prostate, urinary bladder, rectum and dissect the pelvic lymph node to extract the tumor
Mumbai, December 26, 2019:A 47-year-old Mumbai-based Real Estate Contractor never knew his three-decade long Gutkha (Tobacco product) addiction, would result in removal of multiple internal organs and a life-threatening disease. Completely unaware of the severity of the condition, he visited the hospital for not being able to pass urine and was successfully operated for a rare-cancerous tumor at Nanavati Super Speciality Hospital (NSSH) recently.
The patient was diagnosed with Prostate Carcinosarcoma—an extremely rare combination of carcinoma (cancer which arises from epithelial tissue like prostate glands) and sarcoma (cancer which arises from supporting tissue like muscles and fascia). As per the experts, less than 60 such cases have been reported in medical literature worldwide.
In a six-hour-long surgery, team of highly experienced surgeons removed the patient’s prostate, urinary bladder, rectum and dissected the pelvic lymph node in a complete extraction of the tumor which was larger than a cricket ball and weighed about 250 grams.
“It was an exceptionally rare and large tumor. Prior to admission, he had undergone an endoscopic prostate surgery (TURP) for his urine obstruction. However, as problem of urine obstruction continued, his treating physicians decided to perform a prostate biopsy,” said Dr. Vivek Venkat, Uro-Oncology Surgeon, NSSH.
As diagnostic tests revealed an aggressive variant of prostate cancer, he was referred to NSSH. Upon admission, doctors performed an MRI of the prostate and a PET-scan to determine the spread and stage of the disease.
“The MRI showed an extremely large mass, bigger than a cricket ball. The tumour had spread in the entire prostate, infiltrating into the urinary bladder and rectum. Fortunately for him, the PET scan showed no spread anywhere else in the body,” informed Dr Vivek Venkat.
A team of expert oncologists and counsellors explained the family about the absence of any non-invasive or hormonal treatment as a treatment option because of his rare pathology. Considering the age of the patient, doctors suggested a surgical intervention, followed by radiation and chemotherapy if necessary. In all the prior reported cases surgery was considered as the mainstay of their treatment.
“We performed pelvic exenteration, which involved the removal of his urinary bladder, prostate and rectum along with a complete pelvic lymph node dissection. The six-hour long surgery proceeded without complications. Pathological findings of tumour substantiated the diagnosis of extremely rare—carcinosarcoma,” explained Dr Venkat. The patient recovered without any complications and was discharged after ten days.
Discussing the case, Mr. Manpreet Sohal - COO, Nanavati Super Speciality Hospital stressed the prevalence of prostate cancer in men and the direct correlation between tobacco and any type of cancers.
“As per the Indian Medical Research Centre, prostate cancer is among the top three leading causes of cancers in top tier one and two cities of India. Through this case, we wish to highlight the importance of routine urology check-up for all men nearing 45-50 years of age. The case also reinforces the contribution of tobacco and Gutkha to almost all type of cancers and elimination of these preventable causes of cancers should be our top priority,” Said Mr. Sohal
Prostate cancer develops in the prostate—a small walnut-sized gland that produces seminal fluid. Prostate cancer cells may spread to other areas of the body such as bones and lymph nodes. The prostate is the second leading site of cancer among males in large Indian cities like Delhi, Kolkatta, Pune and Thiruvananthapuram and third leading site of cancer in cities like Bangalore and Mumbai as per population-based cancer registries (PBCRs) of India.