Prostate cancer is the most commonly diagnosed cancer in men in Australia, and was estimated to overtake breast cancer as the most commonly diagnosed cancer in Australia in 2022. [1] Back pain is a common symptom of prostate cancer that has metastasized, or spread, to the spine. As chiropractors see many practice members with a predominant complaint of back pain, it is important practitioners are prepared to recognise when a patient may need additional care.
While back pain is not a common symptom of prostate cancer, the case studies laid out below show the importance of chiropractors knowing the signs, investigating when something doesn’t seem right, and being able to work with other multidisciplinary teams as a patient undergoes life-saving oncological care.
The first of the two cases in today’s instalment of the men’s health series proves interesting – but not for the usual reasons. The gentleman in question was 51-years-old and had received a diagnosis of terminal prostate cancer. [2] He was undergoing chemotherapy and had received the news that his cancer had metastasised to the lymph nodes. Having been under regular chiropractic care in the past, he presented with a main complaint of low back pain as well as an expressed desire to improve and maintain his quality of life for as long as possible.
At the time of presentation, he was four-month post diagnosis (following an abnormal prostate exam), and chemotherapy had commenced. Unfortunately, it was not his first experience with cancer as he had previously suffered from leukaemia.
Understandably, this was a time of high stress in his life and this was impacting on his mental health and that of his wife and son. At this point, chiropractic care is arguably not just about checking and adjusting subluxations, but providing support as he waded through the waters of chemotherapy. At the start of care, the patient returned 17 abnormal findings on his functional examination and was found to have a few subluxations in each of the cervical, thoracic, and lumbopelvic spine regions. He was adjusted using Diversified Technique, as well as Charrette’s adjustment protocol for extremity adjustments when necessary.
Because of his condition, care was kept gentle, and only significant subluxations were adjusted at each visit. The treating chiropractor recommended light cardio, when he felt capable of it, and exercises to maintain range of motion. A healthy diet, high water intake, and chiropractic care at a frequency of one session per fortnight were also recommended. The patient was reviewed every 15 visits.
Obviously, the chiropractor made it clear that the aims of care did not include curing cancer – that’s not something we do. But it was about supporting the nervous system of the patient while he underwent cancer treatment. That’s where it got interesting.
At the commencement of the present course of care, four months post-diagnosis, he reported faster recovery from recent chemotherapy. Recovery from the next chemotherapy round, which occurred over the Christmas Holidays when chiropractic care was infrequent, was not as fast. The patient was suffering from lethargy, back pain, and generalised joint pain, consistent symptoms following chemotherapy.
Three months after commencing this care plan, the patient reported he ‘bounced back so much better after his adjustment than he did when he couldn’t be adjusted immediately following round two’. The patient requested to be adjusted the day after chemotherapy and found this to be aiding his recovery. The patient appeared to be coping better mentally.
Add to that the following findings: At the conclusion of the care plan, he returned only 9 of the original 17 abnormal functional examination findings and had an increased range of motion in almost every direction.
Now, it goes without saying that this is a standalone case report and thus findings might not represent how other people would respond to care in the same situations. Additionally, the quality of life and mental health/coping outcomes were entirely self-reported. That said, given a terminal diagnosis, it is remarkable.
But is it a standalone? Apparently not.
Presumptive Prostate Cancer Presenting as Low Back Pain in the Chiropractic Office: Two Cases and Literature Review. [3]
A recently published study illustrated two cases of patients with previously undiagnosed prostate cancer presenting for chiropractic care with back pain. There were several similarities noted between the cases, including both patients being elderly males, having no prior screening, and who had seen other health providers. They had both undergone lumbar radiography and were treated for a non-neoplastic condition.
In both cases, the chiropractor recognised the red flags within the history and presentation. In this case, that included factors such as recent falls, worsening neurological symptoms, gastrointestinal symptoms, and compression fractures. Factors such as these, in conjunction with progressive worsening following care, prompted the chiropractor to refer the patients for an MRI, which led to the eventual presumptive diagnosis of prostate cancer by an oncologist.
The role of the chiropractor in these cases was to recognise the potential serious pathology, and support the patient in seeking the necessary medical care. This is commendable indeed and reinforces the importance of thorough examinations and histories, as well as the chiropractor taking care to investigate and cross-refer for tests where possible.
The chiropractor was able to provide some brief relief of the back pain for each patient, but the main finding was that the chiropractor was instrumental in obtaining a correct diagnosis for a life-threatening condition that had been overlooked by other care providers.
The first case report reveals how chiropractic care may be able to increase the quality of life and mental health of an individual with prostate cancer. As we have seen in other case reports and studies of other conditions, supporting the nervous system gives it the best opportunity for healing and restoring function throughout the body. This case also includes the practice member’s journey of receiving chemotherapy alongside chiropractic care, and how the two fit together into his life. With chiropractic care supporting the recovery process following chemotherapy rounds.
The last two cases highlight the responsibility chiropractors have in recognising red flags and indicators of undiagnosed conditions, including prostate cancer. The cases included an Asian population and discussed the impact screening programs may have had. While countries like Australia and the United States, have established screening programs that assist in detecting prostate cancer as early as possible, there are inevitably individuals who slip through the cracks. You may find these individuals presenting for care in your office, and it is important that you feel equipped to support them in receiving the care they need.
The full case reports are available at the references below.
References:
- Cancer – Australian Institute of Health and Welfare. Australian Institute of Health and Welfare. 2022.
- Seaman R, Postlethwaite R, McIver C. Improved Mental Health and Quality of Life in a 51-Year-Old Male under Chiropractic care: A Case Report. Asia-Pac Chiropr J. 2023;3.4. URL apcj.net/Papers-Issue-3-4/#SeamanMentalHealth.
- Chu ECP, Lai C R, Leung BK. Presumptive Prostate Cancer Presenting as Low Back Pain in the Chiropractic Office: Two Cases and Literature Review. Asia-Pac Chiropr J. 2023;3.4. URL apcj.net/Papers-Issue-3-4/#ChuetalPresumptiveProstateCancer
