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Diagnosed with prostate cancer. Diagnosed with no definite perineural invasion identified. Required treatment?

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Practicing since : 1979
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Diagnosed with prostate cancer,
biopsy result:
left apex 3+4=7
right apex 3+4=7
left mid 3+4=7
left lateral 3+4=7
right mid 3+4=7
right lateral 3+4=7
right base (negative for carcinoma)
left base (negative for carcinoma)

initially 40, than dropped to 33

CLINICAL DIAGNOSIS: No definite perineural invasion is identified.


Posted Sat, 17 Nov 2012 in Blood Cancer(Leukemia)
Answered by Dr. Jawahar Ticku 17 hours later
Thanks for puting this quiry.
Histopathology is not clear. Would like to have detaled histopathological report as regards the cell variety and the CT pelvis report to understand if any pelvic lymphadenopathy.
If it is confirmed adenocarcinoma, I would suggest you to undergo hormonal management. it is called chemical castration. Regular check up of your PSA Under the guidance of your treating Oncophysician. He will let you know the progress in your disease regression. The prognosis with this form of treatment is good.
Dr. J. Ticku
Clinical Oncologist
Above answer was peer-reviewed by
Follow-up: Diagnosed with prostate cancer. Diagnosed with no definite perineural invasion identified. Required treatment? 13 hours later
the cancer cells did not spread outside the prostate ( not to the lymph nodes nor to the bones)
and the XXXXXXX number is 7
his PSA being so high (30-40) is what is worrying.

do you still think chemical castration is the best way to go although the cancer hasn't spread yet?
roughly how long does it take before prostate cancer cells metastasize ( i know it is hard to give me a number), but if you can give me an estimate # from your experience?
how fast do prostate cancer cells divide? ( i am worried everything is taking so long, they way the doctors are scheduling things, after i decide my treatment it might take up to a month before my first it is radiation or something else). My urologist has not mentioned anything about chemical castration by the way and i'm not sure why.

Answered by Dr. Jawahar Ticku 4 hours later
Thank you for the quick response.
Cancer prostate is supposed to be hormone dependant tumor i.e it depends on testosterone.
We have to block the testosterone. Earlier we would advise removal of the testes (Castration) but same result is achieved by chemical hormonal agents called chemical castration, under the guidance of your Oncophysician. Taking this treatment, a 10 year disease free survival is assured. Your Oncophysician will monitor you from time to time to see whether this treatment is suiting you and may switch over to different modality if he finds at any time that you're not responding.
True there are other modalities of treatment like IMRT/ IGRT(RADIATION TREATMENT). A radiation Oncologist will think this is better but my vast experience suggests to start with hormonal management and keep the other forms of management in reserve.
I hope you got my point.
Dr. J. Ticku
Above answer was peer-reviewed by
Follow-up: Diagnosed with prostate cancer. Diagnosed with no definite perineural invasion identified. Required treatment? 19 hours later
Thank you so much for the help!
i just found out that they scheduled me for a consultation with a Brachytherapy specialist, what do you think about that treatment?
Answered by Dr. Jawahar Ticku 5 hours later
Dear sir,
Brachy therapy is a part of radiation treatment which is done by implanting radioactive seeds into the prostate. In view of latest techniques available in radiation treatment this form has gone into background and is rarely done though at some time, it was the best treatment for treating residual diseases. It is a surgical procedure. A radiation oncologist will suggest his own mode of treatment and the oncophysician will suggest you the hormonal management with the beginning of castration which may be surgical or chemical. Once the hormonal dependence of the tumor is weaned away, the tumor cells dry and decay. In view of XXXXXXX score 7, then you need to undergo pelvic radiation as well. Our preference in management is by a protocol which is least morbid and best result oriented. Brachytherapy and other modalities we will prefer to keep in reserve.
Dr. J. Ticku
Above answer was peer-reviewed by
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