74 years old male with symptoms of Prostatism. On USG , cholelithiasis and BHP - Grade 3 PSA examination report is attached. Further management and plan of treatment

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Whether TRUS or digital P/R exam was done within 72hrs prior to taking the test sample? There is chance of increasing the PSA value due to prostate massage caused by the above procedures. Better to go for a TRUS guided biopsy before deciding what to do for this. Regarding cholelithiasis, Conservative management is preferable at this point of time.

Age 74 with bhp gr3 psa is certainly quite high but symptoms are of protatism only. I feel tissue biopsy should be done and confirmed by hpe .i dont think only high psa is the criteria for malignancy as plan of surgery would depend on confirmation only so far cholelithiasis is concerned seems to be asymptomatic and should be left as such.if despite of bhp gr3 there is no obstructive symtoms he can left under followup for next 6months or so with observing psa.

High psa doutdoor the malignancy Do.go.fr biopsy No urinextra stream obst no surgery AT PRESENT SENT ALSO.SEE FOR BONY MRTASIS IF ANY TT CHOLELITHIASIS CONSERVATIVELY RED AS PER YOUR EXPERIENCE ALLOW AS U ARE A BRILLIANT SURGEON

Thank you. Sir
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TRUS guided prostate biopsy If malignancy proved then do staging by MRI pelvis with abdomen and bone scan Surgical/medical castration/EBRT r various option

Thank you Sir
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TRUS guided biopsy from the prostate. CECT chest and abdomen, bone scan for metastatic work up & CEMRI pelvis for locoregional extent if malignancy proved on biopsy.

free to total psa is in benign range. Just to confirm True & sos biopsy. If at all proved to b malignancy which is unlikely then either med or surgical castration. Bone scan & fu

Thank you, Sir
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Sorry Dr yograj printing error may inconvenient fr u

Don't jump the gun.Pt is asymptomatic for prostate as a severe symptom. Do an U/s. Treat with antibiotics for 3 weeks and then repeat psa. At this age of 75 yrs, only a Biopsy for confirmation. Unless there is uncontrovertible evidence of malignancy, and pt is symptomatic, don't aggressively treat for ca prostate. ADT and bil.orchiectomy is the most this patient will need

Radical prostatectomy

Thanx dr Sandip Debashish mishra

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