CASE REPORT

Diagnosis: Prostate cancer with bone metastases

A 61-year-old man started to experience weight loss, weakness, pain in his back and hips as well as difficulty in urination in July 2003. He applied to Denizli Social Security Hospital, and CT scan of the abdomen was performed on 8 August 2003
( Appendix KE1 ). The scan demonstrated a cortical cyst in the right kidney as well as degenerative changes in the bones.
He was prescribed some symptomatic medicines that provided no benefit.

When his symptoms worsened, he was hospitalized on 10 September 2003 at the Internal Diseases Clinic of the Social Security Foundation's Izmir Training Hospital ( Appendix KE2 ). Lab work revealed that ALP was abnormal at 630. PSA was found to be more than 150. Bone scintigraphy performed on 22 September 2003 showed widespread bone metastases in the cranium, bilateral costae, all vertebrae, pelvis, and left femur proximal ( Appendix KE3 ). Prostate biopsy was performed on 23 September and the patient was discharged to be followed up at the urology polyclinic. Pathological examination of the
biopsy specimen revealed the diagnosis as "prostate adenocarcinoma" ( Appendix KE4 ). The patient was recommended some hormone therapy that provided no benefit.

The patient was taken to Dr. Ozel on 3 December 2003. In rectal examination, prostate right lobe was found to be as big as
an egg and very hard. There was a mass of about 3 cm in diameter at the left parietal site of his head; the patient stated that
it started to grow in September and has been causing pain. He had also been experiencing sharp pain in his hips and back.
He had been going to urinate 4-5 times every night. 0.4 mL NOI caused the body temperature to rise to 37.4^o C. The patient
was started on a daily regimen of 0.4-1 mL NOI, six times a week. He was recommended to adjust the dosage according to
maximum fever experienced. He was also advised to receive three times 1cc of NOO (oral) daily.

The patient presented to Dr. Ozel on 15 March 2004 for a follow-up. His general medical condition had improved. He was pain free. The mass at the left parietal site had shrunk in size. Rectal examination revealed a decrease in the size of the prostate also. He had with him a whole body bone scintigraphy that was obtained on 10 March 2004. It showed that bone metastases
in the cranium, bilateral costae, all vertebrae, and pelvis had disappeared; osteoblastic activity increase of significant
intensity was present in the left femur trochanter major, and there were some localized degenerative changes in both knee joints ( Appendix KE5 ). The patient was recommended to continue N.O. treatment.

The patient came for another follow-up on 20 April 2004. His general condition was very good. The findings of the upper abdomen ultrasound scan performed on 14 April 2004 were normal, and PSA was 0.22 ( Appendix KE6 ). The swelling at the left parietal site had further shrunk in size. Some of the findings of the hemogram performed on 15 April 2004 were as follows:
WBC: 13.0x10³/µL, RBC: 6.03x10⁶/µL, HGB: 12.8 g/dL, HTC: 39.1%, PLT: 182x10³/µL. The patient was recommended to continue the NO treatment.

The patient came again on 6 June 2004. He had no complaint. The swelling at the left parietal site had completely disappeared. He was free of any pain. In rectal examination, prostate lobes were found to be normal in size and hardness. He had no complaint related to urination and its frequency. Some of the findings of the hemogram performed on 3 June 2004 were as follows: WBC: 10.01x 10³/µL, RBC: 6.71x10⁶/µL, HGB: 12.9 g/dL, HCT: 40.5%, PLT: 310x10³/µL. NOI injections were not causing any rise in body temperature, and the patient was placed on a maintenance treatment with 0.6 cc of NOI to be administered every other day.

He came back on 2 October 2004. He was living normal day life, but was recommended to continue the maintenance
treatment for another three months, and then stop it.

The patient presented to Dr. Ozel again on 18 April 2005 for a follow up. He had no complaint. The site of the metastasis in
the head was normal. He had no complaint related to urination and its frequency. Prostate's size and hardness were normal. He had a bone scintigraphy performed on 11-12 January 2005; it stated that there were no pathological findings
( Appendix KE7 ). Some of the findings of the hemogram performed on 30 January 2005 were as follows:
WBC: 8x10³/µL, RBC: 6.07x10⁶/µL, HBG: 12.5 g/dL, HCT: 39.6%, PLT: 272x10³/µL.

As in September 2006, the patient has been in complete and sustained regression.