Advice sorted based on the attached Biopsy, PSA, MRI, etc. reports

Saurabh · November 2017

Hello,

My father has been diagnosed with Prostate Cancer. Life has been rather overwhelming for me in the sense that when my father was younger and healthy, my relationship with him was non-existence (there a was good 10 years gap since we spoke just recently). We have both realized that "Life can only be understood backwards; but it must be lived forwards!"

1. If you have experienced a similar diagnosis then sharing the treatments that worked for you would be very helpful!

2. If your a qualified doctor then your opinion would also be very helpful! What do the reports suggest?

3. I would also like to know if a robotic surgery to remove the prostate would be recommended?

4. If there anyone who is in the same situation as me and would like to just talk please feel to send me a private message.

Regards,

Saurabh

My Father's age is around 73 and he has no other major health issues. He was complaining about a back pain for over a year now.

Total PSA Levels over the last year:

18.90 on 01/07/16

30.12 on 19/09/17

2.468 on 29/10/17 (after Orchiectomy on 06/10/17)

Procedure Description:

Contrast and non contrast MRI of the pelvis performed with T1W SE, T2W TSE & STIR sequence in axial & sagittal planes using body matrix coil.

Clinical Indication:

C/o Lower urinary tract symptoms with increase PSA 32.41

Finding:

Prostate is enlarged measuring 3.9AP x 4.6CC x 3.8TR cm with complete loss of zonal differentiation. An ill-defined altered signal intensity lesion is seen involving both peripheral and central zones of prostate gland involving both sides (R>L). It displays diffusion restriction. The central gland is involved more towards base with extension to involve medial part of both vesicles.

There is a capsular bulge along involved areas with suggestion of breach along right lateral aspect. No evidence of rectal and bladder invasion is seen. The lesion is showing heterogenous early arterial phase enhancement with focal areas of early wash out. There are focal areas of choline peak elevation or elevated choline/citrate ratios on MR spectroscopy.

Enlarged round right obturator lymph node is seen measuring 1.6x1.5cms.

Urinary bladder reveals normal morphology & normal hypointensity of bladder wall in T2W images.

Perivesical planes are normal.

Pelvis floor & presacral are normal.

No free fluid is seen.

Major pelvic vessels show normal flow void.

Bony pelvis is unremarkable.

IMPRESSION:

Prostatomegaly with ill-defined large altered signal intensity lesion involving both peripheral and central zone with extensions, right pelvic lymphadenopathy and other findings as described-PIRADS-5.

BIOPSY NO.:B/8294/2017

SPECIMEN SUBMITTED: TRUS GUIDED PROSTATE BIOPSY --------------------------------------------------------------------------------------------
GROSS EXAMINATION:
LEFT LATERAL BASE: SINGLE LINEAR GREY WHITE SOFT TISSUE CORE MEASURING 0.6 cm IN LENGTH (001) (NTL) LEFT LATERAL MID: SINGLE LINEAR GREY WHITE SOFT TISSUE CORE MEASURING 1.2 cm IN LENGTH (002) (NTL) LEFT LATERAL APEX: SINGLE LINEAR GREY WHITE SOFT TISSUE CORE MEASURING 1.0 cm IN LENGTH (003)
(NTL)
LEFT MEDIAL BASE: SINGLE LINEAR GREY WHITE SOFT TISSUE CORE MEASURING 0.6 cm IN LENGTH(004) (NTL) LEFT MEDIAL MID: SINGLE LINEAR GREY WHITE SOFT TISSUE CORE MEASURING 1.3 cm IN LENGTH (005) (NTL) LEFT MEDIAL APEX: SINGLE LINEAR GREY WHITE SOFT TISSUE CORE MEASURING 0.9 cm IN LENGTH (006)
(NTL)
RIGHT MEDIAL BASE: SINGLE LINEAR GREY WHITE SOFT TISSUE CORE MEASURING 1.2 cm IN LENGTH (007) (NTL) RIGHT MEDIAL MID: SINGLE LINEAR GREY WHITE SOFT TISSUE CORE MEASURING 1.5 cm IN LENGTH (008) (NTL) RIGHT MEDIAL APEX: SINGLE LINEAR GREY WHITE SOFT TISSUE CORE MEASURING 1.5 cm IN LENGTH (009)
(NTL)
RIGHT LATERAL BASE: SINGLE LINEAR GREY WHITE SOFT TISSUE CORE MEASURING 1.5 cm IN LENGTH(010) (NTL).
RIGHT LATERAL MID: SINGLE LINEAR GREY WHITE SOFT TISSUE CORE MEASURING 1.0 cm IN LENGTH (011)
(NTL)

RIGHT LATERAL APEX: SINGLE LINEAR GREY WHITE SOFT TISSUE CORE MEASURING 1.6 cm IN LENGTH (012) (NTL) SINGLE LINEAR GREY WHITE SOFT TISSUE CORE MEASURING 1.2 cm IN LENGTH (013) (NTL)
SINGLE LINEAR GREY WHITE SOFT TISSUE CORE MEASURING 1.0 cm IN LENGTH (014) (NTL)
SINGLE LINEAR GREY WHITE SOFT TISSUE CORE MEASURING 1.0 cm IN LENGTH (015) (NTL)

SINGLE LINEAR GREY WHITE SOFT TISSUE CORE MEASURING 0.8 cm IN LENGTH (016) (NTL) SINGLE LINEAR GREY WHITE SOFT TISSUE CORE MEASURING 1.2 cm IN LENGTH (017) (NTL)

MICROSCOPIC EXAMINATION:

001. 10% OF THE CORE SHOWS ADENOCARCINOMA, GLEASONS GRADE: 3+3=6 002. 80% OF THE CORE SHOWS ADENOCARCINOMA, GLEASONS GRADE: 4+3=7 003. 70% OF THE CORE SHOWS ADENOCARCINOMA, GLEASONS GRADE: 4+3=7 004. ..% OF THE CORE SHOWS ADENOCARCINOMA, GLEASONS GRADE: 4+4=8 005. 80% OF THE CORE SHOWS ADENOCARCINOMA, GLEASONS GRADE: 4+4=8 006. 40% OF THE CORE SHOWS ADENOCARCINOMA, GLEASONS GRADE: 4+4=8

006. 40% OF THE CORE SHOWS ADENOCARCINOMA, 007. 80% OF THE CORE SHOWS ADENOCARCINOMA, 008. 90% OF THE CORE SHOWS ADENOCARCINOMA,

PRESENT. EXTRAPROSTATIC EXTENSION SEEN. 009. 90% OF THE CORE SHOWS ADENOCARCINOMA, 010. 80% OF THE CORE SHOWS ADENOCARCINOMA, 011. 50% OF THE CORE SHOWS ADENOCARCINOMA, 012. 70% OF THE CORE SHOWS ADENOCARCINOMA, 013. 80% OF THE CORE SHOWS ADENOCARCINOMA, 014. 70% OF THE CORE SHOWS ADENOCARCINOMA, 015. 80% OF THE CORE SHOWS ADENOCARCINOMA, 016. 70% OF THE CORE SHOWS ADENOCARCINOMA, 017. 90% OF THE CORE SHOWS ADENOCARCINOMA,

GLEASONS GRADE: 4+4=8
GLEASONS GRADE: 4+4=8
GLEASONS GRADE: 4+5=9, PERINEURAL INVASION

GLEASONS GRADE: 4+5=9 GLEASONS GRADE: 4+5=9 GLEASONS GRADE: 4+4=8 GLEASONS GRADE: 4+5=9 GLEASONS GRADE: 5+4=9 GLEASONS GRADE: 4+5=9 GLEASONS GRADE: 4+5=9 GLEASONS GRADE: 4+5=9 GLEASONS GRADE: 4+5=9

OPINION: ACINAR ADENOCARCINOMA, GLEASON SCORE: 4+5=9, GRADE GROUP-5 WITH PERINEURAL INVASION AND EXTRAPROSTATIC EXTENSION.

Clevelandguy · November 2017

Treatment?

Hi Saurabh,

It looks to me that the cancer has escaped the prostate and is agressive. I would think radiation would be the best way to deal with the cancer. You need to meet with an oncologist to see the best method of radiation(ie; Cyberknife, Proton, seeds, ect.) for the treament.

Dave 3+4

ramaka · November 2017

Saurabh:

Saurabh:

My dad got diagonised with a GS=9 earlier this year and his age if 72 years. No matter which Dr(s). we went to ask for opinion in India, the major consesus (irrespective of GS Scores) was to have the Prostate removed and then do a follow-up in a few months post surgery and decide whether to have subsequent Radiation Therapy. My dad got his prostatectomy a couple of months back, follow up visit is first week of January where the Dr will revisit PSA and MRI and see if he needs further Radiation therapy. Wishing you and your dad the best!

Avi.

Saurabh · November 2017

ramaka said:
Saurabh:
Saurabh:

My dad got diagonised with a GS=9 earlier this year and his age if 72 years. No matter which Dr(s). we went to ask for opinion in India, the major consesus (irrespective of GS Scores) was to have the Prostate removed and then do a follow-up in a few months post surgery and decide whether to have subsequent Radiation Therapy. My dad got his prostatectomy a couple of months back, follow up visit is first week of January where the Dr will revisit PSA and MRI and see if he needs further Radiation therapy. Wishing you and your dad the best!

Avi.

Hello Avi,

Hello Avi,

Thank you for your reply. Can you please let me know what stage was the Prostate Cancer? I ask because I have found alot information on the internet that suggest that if the cancer has spread from the prostate then the removal of the prostate is not required? Also having the prostate removed in patients over the age of 70 is not really recommended. I wish your father a fast recovery!

Regards,

Saurabh

Saurabh · November 2017

Clevelandguy said:
Treatment?
Hi Saurabh,

It looks to me that the cancer has escaped the prostate and is agressive. I would think radiation would be the best way to deal with the cancer. You need to meet with an oncologist to see the best method of radiation(ie; Cyberknife, Proton, seeds, ect.) for the treament.

Dave 3+4

Thank you for your valuable

Thank you for your valuable message Dave!

ramaka · November 2017

Saurabh said:
Hello Avi,
Hello Avi,

Thank you for your reply. Can you please let me know what stage was the Prostate Cancer? I ask because I have found alot information on the internet that suggest that if the cancer has spread from the prostate then the removal of the prostate is not required? Also having the prostate removed in patients over the age of 70 is not really recommended. I wish your father a fast recovery!

Regards,

Saurabh

Saurabh:

Saurabh:

My dad was diagonised with T3N1M0. You can find all the details of my father in the below 2 threads:

https://csn.cancer.org/node/308410

https://csn.cancer.org/node/309672.

After reading most of the replies by amazing members of this forum, I too was of the opinion that if the Ca has spread out of the prostate, surgery is not recommeded..at all..but Drs back home think otherwise. We reffered 5-6 Drs (some who were not Onco surgeons) and 99.9% of their reply was to have the surgery and then go with RT post surgery. My dad too wanted the surgery route after listening to their feedback and went with it. Thank you for your wishes and hoping your dad recovers well as well!

Avi.

hopeful and optimistic · November 2017

side effects from treatment are cummulative

Side effects from multiple treatments are cummulative.

Side effects from surgery increase as a man ages, so if a man is 70 and has the exact same operation as a man who is 50 he is more likely to suffer side effects than the man of 50.

With radiation , the permimeter of the the treatment can be extended to be outside the prostate, so the treatment is more extensive. Hormone treatment is usually given in conjuntion, or solely.

Most doctors do not advise surgery with extensive cancer, however some advise which they call debunking.

Advice sorted based on the attached Biopsy, PSA, MRI, etc. reports

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