Diagnosis
Prostatic Acinar Adenocarcinoma. Gleason score – 8 (4+4). Status post prostate tumor biopsy and hormone therapy.
Patient:
Male, 66 years old, Kazakhstan
Physician:
Professor Ahmed Magheli, Chief Physician, Department of Urology, Vivantes Klinikum Berlin
Patient’s Complaints
I have been diagnosed with a malignant neoplasm of the prostate. Tissue samples obtained during biopsy (3 out of 10 cores) indicate prostatic acinar adenocarcinoma. Gleason score: 8 (4+4).
Ultrasound examination showed that the prostate volume is 58.1 cm³. On ultrasound, the prostate appears spherical; the prostatic capsule is clearly visualized with smooth and well-defined contours. The seminal vesicles are not affected. The internal structure is hypoechogenic, and the peripheral zone is hyperechogenic. The residual urine volume is 19 mL. A blood test for prostate-specific antigen (PSA) shows total PSA of 21.7 ng/mL and free PSA of 0.5 ng/mL.
Digital rectal examination reveals that the prostate is enlarged and edematous. The surface is smooth and painful on palpation. Whole-body bone scintigraphy with SPECT of the thoracic and lumbosacral spine shows no focal lesions or changes characteristic of specific pathology.
I am experiencing pain in the urinary bladder, dysuria, weak urine stream, nocturia up to two times per night, a sensation of incomplete bladder emptying, and unstable blood pressure.
Doctors at my place of residence recommend removal of the prostate. Is it possible to avoid surgery and use radiation therapy instead?
Response from Professor Ahmed Magheli
The patient is an ideal candidate for surgery, as he has a relatively aggressive tumor. Due to his urinary symptoms, radiation therapy — which could otherwise serve as an alternative to surgery — is not an option, since radiotherapy tends to aggravate urinary problems.
Patient’s Questions
- My attending physician informed me that surgery can be performed only one month after the biopsy. Is that correct?
- If surgical treatment is necessary, would it be possible to perform the operation using the da Vinci robotic system?
- In that case, how many days would I need to stay in the clinic?
Response from the Physician
- To preserve sexual function, the surgery can be performed six weeks after the biopsy.
- At present, the standard method for prostate tumor removal is minimally invasive nerve-sparing prostatectomy using the da Vinci robotic system.
- The duration of hospitalization in the clinic is 7 days.
Estimated Treatment Cost: €17,000
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