Mar 01, 2014 - 6:53 am
I am hereby mentioning the case as under for your Expert Opinion Patient Name S. Satinderpal Singh (My Father age 63 at Present) diabetic but under control with insulin ( mild dosage )
A) In 2008 PSA was 55.3ng/ml ,biopsy suggestive of poorly differentiated adenocarcinoma ,Gleason Score 5+5, Bone scan was negative for metastasis ,He was prescribed LHRH analogues , and was referred to External Beam Radiotherapy ( As MRI revealed Focal peripostatic infilitration in the right side ,Bilateral seminal vesicles also reveal diffuse hypointensity,subcentimeter bilateral external iliac and inginual nodes were seen - Doctor Said Not fit for Radical Prostectomy - Stage cT3bN0/2M0)
B) in 2010 Patient received 3rd dose of (every 6 months one ) adjuvant hormonal therapy but PSA is rising Serum Psa was 5.86 ng/ml ,MRI Study shows prostate with Altered intensity thickening along the right basal region ,also thickening is noted along the posterior and adjoining right lateral wall of urinary bladder , Doctor Has done HIFU ( High intensity Focus Ultrasound ) as a Salvage therapy for prostate after 3 months waiting as PSA has risen to 18ng/ml
C)After HIFU of ProstatePSA dropped from 18 ng/ml gradually to 0.25 ng/ml upto 2012 , in Early 2013 Psa Starts Rising and risen upto 1.63ng/ml , and recurrence in urinary bladder ,PET CT suggestive of focal wall thickening in the right posterolateral wall of urinary bladder , Doctor did Bladder Tumor Excision by Robotic Surgery 29/7/13
Findings of Histopath Report
Microscopic Examination - Prostatic aciar adenocarcinoma with signet ring cell morphology , Gleason score 5+5
Extent of Invasion : Tumor involves whole Bladder wall with involvement of muscularis proparia and extension into perineural :present while lymphovascular invasion not seen
Margins : the nearest margin of excison is involved by tumor
D) PSA dropped to 0.06 but start rising after only 3 months and has reached 1.67 on 22/2/14 , PET CT indicated Focal wall thickening (2.5X1 .1 Cm in transverse dimension ) with unremarkable FDG uptake in the right posterolateral wall of urinary bladder involving the right VUJ ,with resultant mild to moderate right sided hydronephrosis
MRI on 26/2/14 shows On comparison with Previous MRI Pelvis ( 11/7/13 Before Tumor Excision ) ,there is regression of the wall thickening along posterior superior wall but there is still seen thickening with enhancement in the region .
Patient Condition is Fine and Medically Fit , however having Urinary incotinence after Bladder Tumor Excision and earlier experienced same when HIFU was done
It would be great help to Our Family if you please suggest what should we do now as we met 2 doctors and what they suggest are as under
Treatment Options (Suggested after Consultation )
1,One Doctor Suggest for repeat removal of tumor only with excision ,following with joining of ureter with bladder but after gap of 6 weeks
2. Second Doctor suggest Bladder tumor excision is no solution as it will recur in other 3 -4 months and only good option is Bilateral Orchidectomy or Repeat LHRH agonist/antagonist as more than 3 years have passed in hormonal treatment also he told operation is only successful in case full bladder ,prostate is taken out which is very complicated considering it might stick with rectal wall .
Sir, as a hope please tell as I am only son of my father and I love my father a lot , pls tell solution in which we can extend his life and is better for him considering his age at present 63 and other complication involved in the treatment , in case if you pls suggest some good doctor in India where we get opinion or treatments .I will be thankful from my heart for this kind gesture and helping us in our difficult times .
God Bless You and ur Family , Awaiting your reply eagerly , In case you require any more test reports pls tell I will send you instantly
Kanwardeep Singh Dua