A 7-year-old, neutered male, Bernese Mountain dog had a history of acuteonset, non-painful left hind limb paralysis. The referring veterinarian made a diagnosis of fibrocartilaginous embolism (FCE). As an incidental finding on the MRI, the prostate was noted to be enlarged (2.3 x 2.7 cm) and asymmetrical. Results of an aspiration’s cytology confirmed prostatic adenocarcinoma. The patient had initially been placed on Piroxicam and Misoprostal for treatment of the prostatic tumor, but had started vomiting so his owner stopped the medications. He was not currently on any medications or supplements. The owner was interested in TCVM as alternatives to traditional treatments. The patient was not showing any signs from the prostate tumor at this point. His left hind leg was improving after receiving physical therapy. He was eating and drinking well with no vomiting or diarrhea. His diet was a good-quality dry food with cooked organic chicken and vegetables added. He preferred cooler surfaces and colder temperatures in general.
The patient was an Earth personality and had great Shen. His tongue was red and moist with a thin, clear coating. He was panting in the room. His pulses were very weak and deep bilaterally. He had no sensitivity to Back Shu points. He had a left hind limb paresis. His skin coat was shiny and healthy.
General Qi and Yin Deficiency with local Qi/Blood Stagnation.
Tonify Qi and Yin, clear local Qi/Blood Stagnation/Stasis, soften hardness, and clear enlargement.
GV-20, GV-14, Bai Hui, LI-10, ST-36, BL-40.
Stasis Breaker, 2g BID x 7d, then 4g BID.
Cell Advance 880, Maitake DMG and Maitake mushroom extract.
Two weeks later, he had been doing well at home. His exam was essentially unchanged. Acupuncture treatment consisted of the same acupoints as his initial treatment, with the addition of BL-23, LI-4 and LIV-3. The patient continued to receive acupuncture every 2 weeks for the next 4 months. Over that time, he remained stable, using his left hind leg and getting around well despite having poor proprioception in this leg.
Approximately 5 months after his initial visit, the patient presented for increased weakness on his left hind leg. On exam, his Shen was good, his tongue was pale red and moist, and pulses were very weak especially on the left. His CP deficit on the left was marked worse than latest noted. Acupuncture treatment included all previous acupoints, in addition to BL-26 and GB-34. Wei Qi Booster was added at 2-4g BID. He remained asymptomatic for his prostate tumor during this entire time.
Approximately 10 months after his initial visit, the patient was seen at the local emergency hospital with a concern of difficulty urination and defecation. On physical exam, his prostate was enlarged and painful. Ultrasound confirmed a prostatic mass with an additional 1 cm mass possibly located at the bladder trigone that was partially obstructing the urethra. A urinary catheter was passed to fully empty the bladder, and the patient was given Carprofen 75mg BID for one week. The veterinarian discussed further treatment options, including surgery, chemotherapy and radiation, but the owner preferred to continue with the care that he had already been receiving.
The patient improved at home, and was seen at our hospital the following week. Ultrasound found a large, mineralized prostatic mass measuring 6.5 x 4.2 x 5 cm. The mass was invading the urethra but not the urinary bladder. The bladder wall had thickened, and the bladder contained a large amount of debris and crystals. There was no evidence of local or distant metastasis. A urine sample confirmed a urinary tract infection, and the patient was started on Enrofloxacin 252mg SID and Cefpodoxime 200mg SID x 28 days in addition to Firocoxib 113.5mg SID as needed. Acupuncture every two weeks and daily herbal medicine were continued.
At 18 months post-initial visit, inositol hexaphosphate 510mg BID was added to the patient’s supplements. Other than intermittent episodes of hematuria and mild dysuria which were treated with antibiotics, the patient continued to do well for several months. He maintained an excellent body condition, and was active and in good spirits at home.
Twenty-two months after his initial diagnosis and treatment, the patient began to exhibit signs of frank blood from his penis. He was still bright and alert, eating well, and not straining to urinate. On exam, his Shen was good and had no sensitive Shu point. His tongue was pale red and moist, and his pulses were very weak bilaterally. Acupoints included his usual regimen in addition to LIV-2, BL-22 and BL-39. Yunnan Baiyao was added at 250mg BID and Enrofloxacin at 272mg SID.
A week later, the patient was seen for another acupuncture session. His Shen was a little decreased, but his activity level was still good. He was still having hematuria, but his urinary incontinence and frank blood from the penis had resolved. His owner had stopped giving the Stasis Breaker and Wei Qi Booster as his appetite had decreased, but was still giving the other herbs and antibiotic. On exam his tongue was red and moist, his body warm, and he was panting more than usual. Acupuncture was performed using similar acupoints. Red Front Door, 4 gm BID was dispensed. Sadly, 12 days after this visit, the owner called concerned that the patient could not stand and did not want to eat. He was humanely euthanized at the hospital with his family present.
Prostatic adenocarcinoma is the most common form of prostatic neoplasia affecting male dogs, both neutered and intact. It is typically locally aggressive, invading the regional lymph nodes, urethra, urinary bladder, lumbar vertebrae and bony pelvis. Urethral obstruction is common. Later in the course of the disease, distant metastasis to the lungs and abdominal organs can be seen. Metastasis occurs in about 80% of dogs at the time of diagnosis. Although various treatments, including radiation, chemotherapy and surgery, have been suggested for this type of tumor, there is no effective curative therapy and it is generally poorly responsive to these treatments. Dogs with this tumor are typically given a grave prognosis. Treatment is therefore usually focused on maintaining quality of life, including managing pain, suppressing secondary infections, and maintaining the ability to urinate. If untreated or if surgery is attempted, the mean survival time for dogs is 30 days. When traditional medications are used (Piroxicam or Carprofen), mean survival time can be extended to a reported maximum of 7 months. The longest reported survival time for a dog with prostatic adenocarcinoma is 239 days, or about 8 months.
This case was important on more than one level. On a large scale, it demonstrated the ability of TCVM and Western herbal medicines to manage a disease that has no effective traditional treatments. In reviewing the available literature, I was amazed at the difference in the mean survival times between this case and every other reported case of canine prostatic carcinoma. From the time of diagnosis to euthanasia, the patient lived an active, happy life for 720 days, compared to the 239 days maximum reported in the literature. Even at 10 months after the initial diagnosis, there was no metastasis of the tumor visible on ultrasound. While there is no doubt that early diagnosis was helpful in managing the cancer, this patient’s excellent life quality and complete lack of clinical signs for 10 months following diagnosis is, to my knowledge, unheard of. Our ability to maintain this good life quality for 22 months following the initial diagnosis, and for 12 months after he began to show clinical signs, is outstanding.
In this case, an underlying Qi Deficiency likely contributed to local Stagnation that manifested as both the presumed FCE and the prostate tumor. The principles of treating Qi Deficiency and Stagnation in TCVM are to use acupuncture and herbs to both tonify the Qi and allow it to flow freely. The Stasis Breaker and Wei Qi Booster herbal formulas are commonly used to treat all types of cancer. An additional herbal formula that could have been helpful is Prostate Invigorator. Given the number of other herbs that the patient was taking, and their overall efficacy, it was not used. The Western herbs and supplements used (Cell Advance, Maitake DMG, Saw Palmetto and IP-6) provided further support and addressed the cancer from different angles. Western antibiotics and non-steroidal anti-inflammatory medications were also crucial to maintaining life quality, demonstrating a true integrative approach. Later in the course of treatment, Yunnan Bai Yao and Red Front Door herbals provided symptomatic relief when necessary.