Dear Dr. Tewari,
I feel very fortunate to convey my husband's medical issues to such an esteemed physician. My husband is 65 years old in good health, and was diagnosed with prostate cancer with a PSA of 5.04 (which was 4.33 three days prior in a different lab). His gleason score was 8 ( a big worry to us) . 11 out of 12 samples from both the left and right lobes were benign. The 12th sample was 95% benign with 5% involvement. This diagnosis was called adenocarcinoma.
His DRE was normal and his ultrasound was normal with no lesions, seminal vessels normal in appearance and transition zone moderately heterogeneous. The clinical stage was T1c. He is 6ft 1, weighs 260. Our original urologist who does not do surgery referred us to another urologist who said my husband was too heavy to do open surgery effectively, and he personally did not do robotic surgery. We want to do surgery either robotic or open and would like to know if he is a candidate for either. We like what we have learned about the benefits of the robotic surgery. No other testing such as a bone scan or MRI was done.
We have been made aware of all 6 treatments and know the risks and benefits, but desire surgery. We are willing to travel and hopefully would like your response as soon as possible as time is essential.
We would like to know:
1.Whether Surgery (open or robotic) is an option for him with the information I have given you
2. If further testing such as bone scan is required at this time
3. Your prognosis
4. Any referrals in the florida or ny area (including yourself , if you would see him)
We greatly value your opinion and hope to hear from you as soon as possible as we are very frightened.
Thank you so much,
Thank you for your question. I can understand that the influx of information can be daunting and overwhelming at times. To address your points:
1. Your husband is a good candidate for robotic surgery given the information above. A gleason sum of 8 indicates high grade disease, however, one out of 12 biopsy cores are positive, which suggests that the disease is manageable and hasn't left prostate.
2. A bone scan and endorectal MRI will usually be done to get a better sense of the disease.
3. In my experience, although a gleason score 8 indicates high grade disease, cancer eradication is possible.
4. I would be glad to see you. Please contact my office at 212.746.5638 or send me an email at ***@****.
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