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High PSA level, underwent BIOPSY. Surgery or RADIATION SURGERY?

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Name : Gopinathan Nair
Age : 70 years

I have couple of question regarding my treatment . My PSA level was very high when I did the blood test. I have attached the detailed reports. After this I have gone through various examinations and tests including biopsy. Please let me know what you suggest, is it needed to be removed?

1. Exactly what type of prostate issues do I have & what treatment do you recommend and why?
2. If I have surgery, will the nerve bundles be spared? Will the surgery be laparoscopic?
3. If I have radiation, what types of radiation therapy might work best for me?
4. What are the pros and cons of radiation versus surgery in my case?

Category: Oncologist

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Category: Hematologist
 31 Doctors Online

Thank you for your query at
1. The diagnosis as per the bone scan is metastatic prostate cancer (which means disseminated disease) for which the type of treatment needed is mainly hormonal therapy. This is for eliminating the testosterone levels from the body. For more clinical confirmation I would suggest to doa biopsy from the bone lesion to rule out carcinomatous involvement.
2. For metastatic cancer, the treatment will be to remove the testes. this is the major supply of testosterone in the body. Removal of testes eliminates the main source of this hormone and can be followed up with hormonal tablets.
3. Radiation depends on the need. You have to specify the need.
4. Surgery as testes removal will be the surgery in your case, if considered to have metastatic disease.
Feel free to discuss further,
Dr.E.Prasad, M.B.B.S., D.M.R.T., M.D., D.M (Onco)

Patient replied :

Hello, Thank you for an early response. 1. As diagnosed by your team that it is a case of metastatic prostrate because of the report of bone scan shows Conclusion of increased tracer uptake in left clavicle and left 4,5,6th arterial ribs, this may be due to an accident Which happened about 2months ago. To correlate this, the blood report which I had send shows ESR (erythrocyte sedimentation rate) 14mm in 1hr. 2. Also for correlating the bone scan finding clinically I had been told to undergo a MRI scan which will be done on11th of this month. I request to re examine the document and suggest a treatment.

The prior history of accident was not mentioned in the previous consult. I would really appreciate a complete past history about the patient to clinically correlate the investigation findings and thereby help you better. Please understand that the consults are answered only based on these reports without examining the patient.
The biopsy from the prostate reveals cancer with high Gleason grade. This requires complete metastatic evaluation prior to starting therapy. Metastatic evaluation requires CT scans of the abdomen and pelvis and CT scan of the chest. Bone scan already done shows few uptake in the left side which has been attributed to a prior accident.
Kindly revert back after completing the metastatic workup. In case of metastatic disease (disseminated disease), the treatment option would be as described in the previous consult.
In case of local disease, treatment choices are between either surgery or radiation. Best is Radiation, considering the Gleason score, option would be to opt for RAPID ARC or TRUBEAM or IGRT or IMRT.

Patient replied :

hello sir,
As suggested by you we did the MRI and am attaching the result to you.
1. Now based on the results pls suggest the treatment to undergo.
2. And based on the report please tell the possibility of reoccurence post treatment.

Thank you for your follow up.
In order to be able to evaluate metastatic requires CT scans of the abdomen and pelvis and CT scan of the chest. Your attached report only shows reporting on MRI of the pelvis. CT chest study reports needed are required to give an appropriate opinion.
If they are normal, then further treatment line will be Radiation therapy with or without hormonal agent.. IMRT (Intensity modulated radiation therapy) or IGRT (image guided radiation therapy) will be the preferred modality.
Kindly understand that I am not in a positon to comment on possibility of recurrence without the the CT chest study reports.
Hope this addresses your concern. Feel free to discuss further.

Patient replied :

Hello sir, Thank you for the reply, with the mri report i tried to upload the mri images but couldnt do because of the upload limit of the site. Kindly sugest how to upload

Well in that case, kindly send the entire reports to our email [email protected]
I assure you that the content is maintained confidential.

Dr. Prasad Eswaran
Category: Hematologist
Doctorate in Medicine (Fellowship in Oncology), DM,  Madras Medical College & Govt. General Hospital, Chennai, India.

Doctor of Medicine (Residency in Radiation Oncology) , MD, Christian Medical College, Vellore, Tamilnadu, India, 2004-06.

Diploma in Medical Radiology & Therapy (Residency in Radiation Oncology), D.M.R.T, Madras Medical College & Govt. General Hospital, Chennai, India, 2004-06.

Bachelor of Medicine & Bachelor of Surgery - M.B.B.S, Govt. Stanley Medical College & Hospital, Chennai, India, 1998-2004.
Dr. Prasad Eswaran and 4 other Medical Specialists are ready to help you

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