Prostate Cancer Case Studies - Episode 4

Case Study: Postoperative Treatment of Prostate Cancer

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Moderator, Raoul S. Concepcion, MD, presents a case study of a 62 year-old Caucasian patient with a PSA of 6 ng/mL and a strong family history of prostate cancer. Following an evaluation, the patient decided to undergo a 12-core biopsy, which found that 4 of the 12 cores were 40% to 60% positive for Gleason 4+3 disease.

As a result, the patient elected to undergo robotically assisted radical retropubic prostatectomy. According to the final pathology report, Concepcion explains, the Gleason score was 4+3 and the lesion was pathologic stage T3a with a questionable apical surgical margins. Overall, the patient was node negative without evidence of metastatic disease. At 3 months following surgery, the PSA nadir was determined to be 0.2 ng/mL.

Several of the postoperative indicators seem to note the presence of residual disease, particularly the lack of an undetectable PSA level, believes Leonard G. Gomella, MD. As a result, a nomogram should be utilized to gauge the risk of recurrence. If the risk is greater than 50%, adjuvant radiation therapy should be administered.