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Prognosis of Clinical stage t4 of prostrate cancer - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Excellent Posted in: Cancer
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1777 Questions
Doctor :   Hi
Doctor :   How can I help you?
User :   hellocan i ask u a question
User :   one of my freind is having stage t4 prostrate cancer
Doctor :   Ok
User :   orchidectomy and turp done
Doctor :   Yes, we had a chat before.
Doctor :   As
User :   what is the prognosis
Doctor :   Are there any nodal metastasis?
Doctor :   Are you with me
Doctor :   I have to close this window since there is no response from your side, please get back to us if you need further medical advice. We are available round the clock.
Doctor :   Hi
User :   hello sir i am back
Doctor :   Are you back ?
User :   yes sir
User :   MRI shows no nodes
Doctor :   Ok
User :   but his preop psa was more than 100 veyr high isnt that
Doctor :   Yes, it is very high, but the PSA is elevated even in BPH
User :   he had eleveted rft which subsided after stenting
User :   okay sir
Doctor :   Once after the treatment, the elevation will have to be known.
User :   gleasons score was 4+4 8
User :   okay hes othersise in good condition no bp not a sdiabetic
Doctor :   Can you mention his height and weight?
Doctor :   Ok
User :   hes 5 feet 7 inches
User :   and wieght 60kgs
Doctor :   Ok
Doctor :   The 5 year survival rate is usually about 50% if it is node negative
User :   okay sir
Doctor :   But he needs frequent monitoring,
User :   does chemotherapy has a role in this condition
User :   okay
Doctor :   with Digital Rectal Examination and PSA
User :   okay that hes willing to undergo
User :   hes willing to undergo all testes
Doctor :   Radical surgery is the treatment to be done
Doctor :   Was a histopathological examination done on the specimen?
Doctor :   Can you tell me the grade there?
User :   grade glesons grade?
User :   you mean Gleasons grade
User :   its written as 4+4
User :   i will type the whole hpe reprot now
Doctor :   Ok
User :   Micro: Section from prostatic cores show an invasive tumour composed of sheets, cords, trabeculae and occasional acini of malignant cells with hyperchromatic nuclei, some prominent nucleoli, moderate- abundant, eosinophilic- clear cytoplasm surrounded by fibromuscular stroma. Few benign prostatic acini lined by bilayered epithelium are also seen
User :   sir you got teh report
Doctor :   Yes
User :   what do you think now of porgnosis ?
Doctor :   The prognosis is better as the tumor is not showing sever anaplastic changes
User :   okay thats good to know
Doctor :   But as the score is 8 the tumor is still high grade
User :   okay
User :   hes otheriwse helathy and not veyr old only 58 years of age
Doctor :   It is better if he undergoes a staging CT scanning and bone scan.
User :   okay
User :   they are palnning for bone scans
Doctor :   Ok
User :   if bone is positive for mets, what would be the treatment?
Doctor :   That will help in deciding the prognosis better
Doctor :   Serum PSA is measured every 3 months for the first 2 years.
Doctor :   If undetectable, the interval is increased to every 6 months until 5 years postsurgery, when it can be measured yearly.
Doctor :   By what you have said, I could identify the grade as T4 but have the doctors examining him given the TNM staging as their staging will be more accurate as they have physically examined him.
Doctor :   Are you with me ?
Doctor :   I could be wrong with the TNM staging as I have not physically examined him.
User :   yes sir
User :   okay thank you very much for the inofrmations
Doctor :   You are welcome
User :   Prostarte cancer as such is low grad etumour isnt it?
User :   not very much maliganat i mean ?
Doctor :   The Gleason's score is high but if the tumor grade is low, then the
Doctor :   prognosis will be different.
User :   okay hope he does well
User :   hes otherwise helathy very much helathy
Doctor :   Ok
User :   no diabetes no hypertension no oebstity and hes very actiev now
Doctor :   Then it would be better if you follow the PSA titres every 3 months
User :   looking at his hpe report, what do you feel the tumor grade is ? high or low?
Doctor :   The gleason of 8 is high grade
Doctor :   But as you said that distant organs have not been involved,
Doctor :   the extent of the local spread
Doctor :   needs to be known
User :   so he must do well isnt it?
Doctor :   That can be known with the TNM staging
User :   i saw his mri report no nodal spread
Doctor :   IOk
Doctor :   Was a radical prostatectomy done?
User :   no here the urologist said radical prostatectomy doenst have much role and probbaly rchidectomy and follow up is the best
User :   i dont knwo weathe rthis doctor doesnt know how to do radical prostatectomy and he shyed awaty from it
Doctor :   Then in that case a relatively good prognosis can be expected.
Doctor :   But constant monitoring is required.
Doctor :   Ok
User :   if i need a second opinion on this case which centre in ,,, you think is teh best for prostarte cancer
Doctor :   Where are you located as of now?
Doctor :   We will get back to you with the relevant details?
Doctor :   Email : YYYY@YYYY
Mobile : 0000
Doctor :   Please confirm your details
User :   correct
User :   you cna mail me or call me
User :   Is it true that ca prostarte is common in people who had sex with many woman this man who si teh pateint is a known womensier
Doctor :   We will send you the details via mail.
User :   he ahd many many women in his life
User :   is it true sir
Doctor :   Ok
User :   i myself also a slight womeniser has many women what precautions i should take to prevent cancer? just aksing sir dont misunderatdn me i cnat liev with out women
Doctor :   That probably has nothing to do with this.
User :   okay
User :   do we get any cancer when you have multiple women
Doctor :   Age, family history, high fat diet
Doctor :   and high testosterone levels
User :   okay
Doctor :   contribute to this
User :   okay sir
User :   but does sex with many woamn cause nay cancer?
Doctor :   As for womanizing in general, it is better not to considering the chances of STD
User :   okay
User :   but sir i cnat live ithout it
User :   how do prevent sideeefeects of sex with many woman
Doctor :   Constant STDs can cause precancerous lesions on the penis and may dispose o squamous cell carcinoma
User :   any precautions i cna take
User :   will suing a condom help?
Doctor :   It is better to avoid ideally. If not, it is better to use a barrier like a condom
User :   good
User :   is there any medicine that willd ecrease my excess sexual drive ?
User :   sir as far I am concerned i just cant resist sex
Doctor :   No, a good healthy diet, avoidance of smoking and alcohol and regular exercise help
User :   okay does non veg diet predispose to excess sexual drive?
Doctor :   It is said to but there is no conclusive eveidence.
User :   i love oral sex more than vagnial sex
Doctor :   Oral sex has more predisposition to STDs
User :   really oh god
User :   we have oral sex with condom is it safe?
Doctor :   Yes,
User :   but its like eating a choclte with wrapper on...
Doctor :   Please fill the feedback form say done when done
User :   i did it
User :   i ma relaly happy iwth you
User :   may i know what branch of medcine you are in?
User :   are you a urologist or generlaist?
User :   you have been very helpful
Doctor :   I am a General Practitioner
User :   I thnk you for this
User :   name?
Doctor :   You are welcome
Doctor :   Anything else I can help you with?
User :   cna you tell me is leucopneia a common manifeatstion of viralm infectio
User :   is a wbc count of 1700 too low?
User :   answer me sir
Doctor :   Leukopenia is seen in Enteric fever generally
User :   sir anwer me
User :   but what about viral fevers wil it cause viral fever
Doctor :   It is unlikely
Doctor :   Anything else?
Doctor :   to have it in viral fevers
Doctor :   Thanks for consulting Healthcaremagic. Bye for now. Please refer your friends to our service.
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