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Dr. Andrew Rynne

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Exp 50 years

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Can hormone therapy be used to check prostate cancer?

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Dr. P. T. Patil

Urologist

Practicing since :1971

Answered : 9823 Questions

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Posted on Sat, 30 Aug 2014 in Urinary and Bladder Problems
Question: My father is diagnosed with a Prostate Cancer with a XXXXXXX score of 7. He went through a TURP and a biopsy which showed this result. After that my father did Urine test and he had infection with Pus cells 18 - 20 and RBC cells 40 - 60. After 10 days he again had a test and now Pus Cells are 40 - 60 and RBC count is 2-3.

What does that mean? Is the cancer spreading after TURP or infection has increased.

We don't have bone scan and MRI done yet to check the spread of prostate cancer. Doctor has advice after 6 weeks if the surgery is required , else he suggested go on hormone therapy as spread need not be checked.

Please suggest what we should do next?
Are we going in right direction. I am very worried for my Father and want him to survive atleast 15 years.

I am attaching latest urine report.
Password is XXXXXXX
doctor
Answered by Dr. P. T. Patil 1 hour later
Brief Answer:
Needs to be evaluated further.

Detailed Answer:
Hello
Thanks for your query,based on the facts that you have posted your father has Cancer of the prostate.
At the out set I would like to state that you are not going in right directions .Standard protocol that is followed by most of the Urologist is as follow

Whenever there is suspicion about the cancer of the prostate after reading of serum PSA are raised more than 4 ng.following investigations are done to find out the stage of the cancer and to confirm whether it is confined to prostate gland or spread to surrounding structures or distant metastasis in bones and lymph nodes.
1) Ultrasound guided multi core biopsy of prostate and to detect Gleasons score.
2) MRI and pet bone scan are mandatory to find out whether it has spread to surrounding structures or bones.and for staging of cancer.

Decision as regards treatment is taken depending upon the stage of the cancer.

If the disease is confined to prostate Open Radical Prostatectomy is the ideal surgical procedure that is practised in most of the centres.or Radiotherapy

If the disease has spread beyond capsule of prostate and to bones palliative surgery of TURP with castration (Bil Orchidectomy followed by hormonal treatment is advised ) with monitoring of serum PSA levels every 2 months to decide further course of action.

There are other modalities of treatment
1) Radiotherapy and Chemotherapy depending upon the serum PSA levels after castration. (Orchidectomy)

The presence of pus cells and RBCs in urine has nothing to do with cancer of prostate It just signifies presence of active infection .

I would suggest you to consult Dr.Bansal who is well known Uro Oncologist in XXXXXXX for further treatment.

Hope I have answered your query ,please feel free to ask if you have more questions ,
I shall be happy to help you
Thanks and Regards.
Dr.Patil.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. P. T. Patil 51 minutes later
Thanks!! for the detailed reply Doctor.
Let me tell you some more background.

1. My father was having difficulty in passing urine and was feeling easy. After this he went for a PSA and Glucose test.
2. His PSA was 15.3 and Glucose was 518.
3. After the test he was immediately admitted to Apollo hospital. Where doctors suspected he has some infection in prostate or urinary path.
4. They first controlled his glucose and after that they did a TURP + Biopsy.
5. After that doctor said we cant do MRI and Bone Scan for next 6 weeks . As of now only 2 weeks have passed and we are waiting for his MRI and Bone scan to happen.

His last PSA Score was : 18.6 as per Apollo discharge Summary.
His Ultrasound was done and everything Liver, Kidney , Bladder and other organs were normal and healthy. There was no issue show in ultrasound except enlarged Prostate.

I have few questions now:

1. His XXXXXXX Score is 7 and his PSA is 18.6 does that indicate that or can it be predicted that his cancer has not spread to bones. Have you ever heard about any patient with these scores having spread cancer.
2. Is there a cure if cancer has spread to bones.
3. what are chances of survival.
4. Is there any diet which he should follow to treat or cure prostate cancer.
5. How long a person survive after prostate cancer?
6. After surgery will prostate cancer be fully cured.
7. Can you give me full name and contact of Dr Bansal.

Regards
XXXX
3.
doctor
Answered by Dr. P. T. Patil 6 hours later
Brief Answer:
Read Detail Answers below.

Detailed Answer:
Hello
Thanks for follow up and detail notes.

Your father had obstructive urinary symptoms with raised PSA and high blood sugar levels.
One can have raised PSA if patient has retention of urine and infection .However it is standard protocol to treat the infection with appropriate antibiotics and repeat the PSA after infection subsides If the second reading also turns out to be higher than 4ng it is considered to be cancer of the prostate unless proved otherwise by doing Ultrasound Guided Transrectal Multi Core Prostate Biopsy. (TRUS) to confirm the diagnosis.

I think this was not done in your fathers case and he was subjected to TURP assuming that he has benign enlargement of prostate and prostate chips resected during surgery were sent for histopathological examination which turned out to be Cancer of Prostate.

Now I would suggest you to get Pet Bone Scan and Radio Nuclear Studies done to trace out for any micro metastasis anywhere in other organs lymph nodes or bones to be rest assured about spread of the disease.

I would answer your queries point to point.
1) It is rather difficult to predict metastasis with this PSA level as one could have raised PAS due to acute retention of urine and infection.
2) Metastasis in bones suggests advanced stage of the disease and can be be controlled further spread and relieving symptoms with chemotherapy or hormonal treatment.but cannot be cured.
3) If cancer has not spread to bones or lymph node chances of survival are good enough provided his PSA levels are monitored at regular intervals.
4) Diet has minimal role to play in Cancer of Prostate.
5) It is difficult to predict to predict duration of survival as his primary cancer is not removed completely by doing TURP.
6) TURP is not a standard treatment for cancer of the prostate as it is not removed completely. As biopsy has confirmed cancer of the prostate after TURP it has to be followed by castration (Bilateral Orchidectomy)and oral hormonal treatment to suppress Testosterone levels for rest of his life .
7) Dr Bansal XXXXXXX XXXXXXX is based in XXXXXXX .
XXXXXXX No-0000
Land Line No-0124-0000.
Hope I have answered your queries
Thanks and Regards.
Dr.Patil.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. P. T. Patil 15 hours later
Thanks Doctor..

Some updates

Today we went to the doctor who did my Fathers TURP and Biposy. We asked him Few questions and answers to them are below

1. We asked him Since he did the TURP can he predict the spread of cancer outside prostate.
A. HE said he is 100% sure it's not outside the prostate.

2. We asked him shall we go for the Bone Scan
A. He said you can go but anyways if the options is surgery you can wait for next few weeks.

3. We asked him for next steps.
A. He said surgery is the best option for my father.

Sir my few questions to you are:

1. Can TURP cause or lead to Prostate Cancer Spread in the body. Has there been any such incidence in the past.
2. I have read at many places Tomato is a good source for stopping the spread of Prostate cancer , how true is this?
3. I heard lot of clinical trials are going on in Prostate cancer Cure and treatment. Will there be any new better solution which is predicted in coming future.

Waiting for your response.
doctor
Answered by Dr. P. T. Patil 8 hours later
Brief Answer:
TURP willnot cause spread of the cancer.

Detailed Answer:
Hello
Thanks for follow up.
1) TURP itself will not cause spread of the cancer per say .If spread has to occur it will spread by direct infiltration to surrounding tissue or to bones via blood stream.
2) I have not heard of efficacy of Tomato in preventing spread of cancer prostate Claim has to be supported by clinical trails conducted scientifically and .accepted by medical fraternity.
3) It is difficult to predict out come of any clinical trials unless they are put in our basket.It is ongoing process and we have to hope for best.

I humbly beg to differ with opinion of your Urologist and my argument is as follow.
1) What was the hurry in going for TURP when Serum PSA was high and not doing MRI and Ultrasound Guided Prostate biopsy (TRUS guided prostate biopsy) or Bone Scan.It would have helped us to to be sure of that it is not cancer and just benign enlargement of prostate where TURP is treatment of choice.
2) What is the reason for not doing bone scan now ? It will cost you few more thousand rupees but will help you to alleviate your tension and anxiety .
3) I do agree that surgery of Radical prostatectomy is the first treatment option provided it is proved to be organ confined disease.

I do not want to go into debate about what has happened but what ever is best for your father has to be done. Now I personally feel he should be investigated thoroughly before taking decision.If he would have been my patient I would go as per following lines.
1) Do MRI and Bone scan to confirm that it is organ confined disease and if other parameters are reasonably normal to withstand major surgery Open Radical Prostatectomy or Robotic assisted Radical prostatectomy is the treatment of choice.( Dr Bansal is pioneer of Radical Prostatectomy in XXXXXXX )
2) If unfortunately turns out to be that it has already spread he should go for castration followed by hormonal therapy.and monitor serum PSA at frequent intervals.

Hope this will help you to take decision.
Thanks and Regards.
Dr.Patil.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. P. T. Patil 41 hours later
Dear Doctor.

Thanks for your advice.
We got bone scan done for my father and the Bone metastases was negative (It was not present)


What should be our next step. We cant get MRI done till 1st week of Septembet as TURP was done 3 weeks back.

Is there any precaution or treatment we should take so that Cancer doesn't spread in these days.

ONCE MRI result comes we will decide we should go for surgery or hormone therapy or radiations.

Please suggest.

Best Regards
XXXX
doctor
Answered by Dr. P. T. Patil 6 hours later
Brief Answer:
No harm in doing MRI even at this stage.

Detailed Answer:
Hello
Thanks for follow up.

Glad to know that it has not spread to bones.

Doing MRI at this stage will not harm or give any negative results because it reflects anatomical landmarks of the disease(Cancer) .It will help to diagnose the real situation and relieve your tension and anxiety.

Take your own decision and get it done as per your convenience.
Thanks and Regards.
Dr.Patil.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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