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What treatment would you recommend for a patient with prostate cancer and elevated PSA levels?

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Posted on Wed, 22 Aug 2018
Question: Hi
What treatment would you recommend - particularily that will have best chance of "curing" the cancer? I have seen a Urology surgeon and a Radiation onclologist for consultation.
My PSA was 2016 Nov 5.2 - 2017 Nov 5.2, Jan2, 2018 6.3, and sent to London Eng lab XXXXXXX 25, 7.42
My biopsy in Oct (I can upload if you like) was 15% cancer, 30% pattern 4 and 70% pattern 3
I have a moderately enlarged prostate
I am 70 yr old very fit - bike 20 km / day or xc ski 10 km
I have asymptomatic stenosis tricuspid valve that does not bother me.
thank you
XXXXXXX XXXX
doctor
Answered by Dr. Monish De (3 hours later)
Brief Answer:
Radiation.

Detailed Answer:

Hello,

After going through your history, I would advise you to go for radiation treatment since you are having prostate cancer and a higher trend of PSA.

Since you are also having tricuspid valve stenosis administering chemotherapy, in this scenario, will be little risky as these drugs are mostly cardiotoxic.

If you have any further queries I will be glad to help.

Regards.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Monish De (3 hours later)
HI

Would you recommend Brachytherapy and not Prostatectomy?

Is my rise in PSA a serious sign?

How much of a hurry should I be in?

thanks
XXXXXXX
doctor
Answered by Dr. Monish De (1 hour later)
Brief Answer:
Low dose implant brachytherapy.

Detailed Answer:

Hello,

Since your PSA in XXXXXXX was 7.42 it is quite high.

Normal PSA is considered as PSA levels of 4.0 ng/mL or lower.

I would advise you to go for low dose implant brachytherapy.

It delivers radiation internally.

These are recommended for low grade prostate cancer as you are having in which 80 and 100 radioactive seeds, the size of a grain of rice, are implanted directly into the prostate.

Each seed releases low energy level radiation steadily over several months.

These brings the PSA down to the normal range.

You should go for it immediately.

If you have any further queries I will be glad to help.

Regards.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Monish De (1 hour later)
Thanks for advice

Why do you suggest Brachytherapy over Prostatectomy?

thanks again
XXXXXXX
doctor
Answered by Dr. Monish De (22 minutes later)
Brief Answer:

Brachytherapy is suggested over prostatectomy due to complications.

Detailed Answer:

Hello,

I would advise brachytherapy over prostatectomy because you are having history of tricuspid valve stenosis and complications may arise during the time of surgery.

I would advise you to take diuretics and aldosterone antagonist with your doctors advise for your heart problem.

You should be on low salt diet.

Since you are asymptomatic at this moment medications and diet will manage your tricuspid valve stenosis problem but in future if it becomes symptomatic then i would advise you to go for percutaneous balloon tricuspid commissurotomy.

If you have any further queries I will be glad to help.

Regards.

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Monish De (46 minutes later)
I can have Brachytherapy in about 3 weeks - or surgery in about 5 weeks

Is that soon enough do you think

My stenosis gives me no trouble and 2 surgeons do not think it will cause problems

Do you still recommend Brachytherapy

thanks again - I appreciate your time
XXXXXXX
doctor
Answered by Dr. Monish De (0 minute later)
Brief Answer:

I will still recommend brachytherapy.

Detailed Answer:

Hello,

I will still recommend brachytherapy in about 3 weeks.

It will be very safe for your health.

It bring PSA down very rapidly.

Wishing you best of health.

If you have no more queries you can close the answer.

Regards.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Monish De (10 hours later)
HI Just one more question

Is Brachytherapy as effective as prostatectomy?

thanks XXXXXXX
doctor
Answered by Dr. Monish De (6 minutes later)
Brief Answer:
Brachytherapy is 50 percent more effective than prostatectomy.

Detailed Answer:

Hello,

Brachytherapy is 50 percent more effective than prostatectomy.

Prostatectomy is associated with more incontinence and sexual dysfunction than brachytherapy.

Therefore I would advise you to go for brachytherapy.

Please consult a radiation oncologist for it.

Take care.

Dr. Monish De, Oncologist
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Dr. Monish De

Oncologist

Practicing since :2004

Answered : 2233 Questions

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What treatment would you recommend for a patient with prostate cancer and elevated PSA levels?

Brief Answer: Radiation. Detailed Answer: Hello, After going through your history, I would advise you to go for radiation treatment since you are having prostate cancer and a higher trend of PSA. Since you are also having tricuspid valve stenosis administering chemotherapy, in this scenario, will be little risky as these drugs are mostly cardiotoxic. If you have any further queries I will be glad to help. Regards.