Dear XXXXXX,
Thanks for writing in.
To help me guide you better, please provide me with the following details:
a.     Was a biopsy performed after your prostate surgery. If yes, what was the histological report?
b.     What was PSA level before surgery or immediately after surgery?
For the time being you don't have to worry. Your PSA level is completely within normal range. You need not undergo any radiation at the moment. A drug may be required after knowing the biopsy details ( hormones) to keep the disease fully under control.
Truly,
Dr. J. Ticku

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Dear XXXXXXX

Thank you for giving me the additional details. But the histopathological diagnosis (biopsy report) is not provided. That would have been very helpful to understand and comment about your problem.

Currently you do not need an active management. You can remain under observation and only periodic Prostate Specific Antigen (PSA) needs to be monitored. You have a very good prognosis and so you need not worry.

Hope I have answered your query. Let me know if I have missed out on any other concerns.

Truly,
Dr. Jawahar Ticku

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Dear XXXXXXX XXXXXXX

Thanks again for writing back.

Since you are asymtomatic and clinically there is no evidence of disease, I wouldn't suggest any treatment. You need to remain under observation.

Studies have shown there is no useful purpose if treatment is started in asymptomatic and where there is no clinical evidence of disease. If at all at treatment is needed, you can undergo hormonal management once a month / once in three months hormonal injection in consultation with the same or a different Oncologist. Discuss with your oncologist

Hope this helps. Let me know if have further concerns.

Truly,
Dr. Jawahar Ticku

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Dear XXXXXXX
you have provided me the XXXXXXX score but not the histopathological details. All tumors are not sensitive to chemotherapy. Majority of the prostate tumors are hormone sensitive. The XXXXXXX score you provided me is intermediate risk disease.
In this condition you can undergo prostatic irradiation by IMRT or IGRT. followed by hormonal treatment which is by three weekly or 6 weekly injection in consultation with your Oncologist once it is established that there is recurrence. Once these modalities are faliures then chemotherapy is considered. The rise of PSA has been after a period of 3 yrs. which can be due to other causes also. Merely on the basis of mild increase in PSA chemotherapy is not indicated unless hormonal management has been given chance.
I hope I am clear to you. If you have any more doubt you can continue to raise the questions.
Truly
Dr. XXXXXXX Ticku

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