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

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Saurabh_D
Saurabh_D

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/8294/2017SPECIMEN 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.

 

 

 

 

0 likes, 2 replies

2 Replies

  • Anonymous111
    Anonymous111 Saurabh_D

    Posted

    Is he losing weight?

    What did the consultant urologist think was the best course of treatment?

    From the reports i’m afraid it sounds as though its already spread to a surrounding lymph node. Did they propose to remove this when doing radical prostatectomy?

     

  • Roger2Dodger
    Roger2Dodger Saurabh_D

    Posted

    SaurabhD

    with his past PSA readings and his Gleason score,and Piraids of 5, I agree wit Ben,sounds like it’s spread to the surrounding lymph nodes . My advice would be listen to your Urologist, and even get a second opinion on course of treatment, you have time to do this, I wouild carefully consider all options,

    with his medical findings he certainly needs some form of treatment,  I have read his medical report entirely, but I am not a Doctor, I would get 2 opinions and carefully consider all options of treatment, 

    This is what.  I did, and was glad I  did just that, 

    Good Luck 

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