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Suggest Treatment For Low Grade Fever And Lymphadenopathy

Posted on Fri, 6 Jan 2017

Question: My father 73 years old.. TURP done in Nov 2016 histopatholgical report indicates benign hyperplasia
Weigh loss (improving now) low grade fever (not there for few days now) vertigo (very recentl) general Malaise and loss of appetite (improving)
PSA 179 ESR96 ALP 536
PET SCAN shows lymphadenopathy (report attached)
Recent TRUS report attached (done on behest of same urologist who did TURP report attached)

Would love to know future plan of action.. Biopsy or not.. Use of chemo if cancer is the cause..

Answered by Dr. Deepak Sundriyal (35 minutes later)

Brief Answer:
Hello dear. Treatment will depend upon the stage.

Detailed Answer:
Hello dear. I have gone through the details. I can understand your concern.

So with a PSA of 179 , it looks like a case of prostate cancer. Treatment will depend upon the stage of disease. Please upload the reports of PET-Scan as well as TRUS. You can simply upload/attach them at the reports section.

A biopsy is needed to confirm the diagnosis and only after that we can start the treatment.

Thanks and regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Deepak Sundriyal (18 minutes later)

I have uploaded the reports.. Thanks for answering my query
I would love to know your opinion provided its carcinoma or Prostate or Lymphoma.. I know biopsy will give me a label.. But do you think there is any other reason for these findings.. And provided this is malignancy then what will be the line of action and prognosis. I am dentist myself, I don't want to put him through the process with low prognosis and he feels the same.
Waiting for your valuable opinion
Thanks..
Regards

Answered by Dr. Deepak Sundriyal (9 minutes later)

Brief Answer:
Hello dear. It is carcinoma

Detailed Answer:
Hello dear, i've reviewed the reports.

For all practical purposes, it will be a carcinoma as lymphoma of prostate is very rare entity and psa rises only in carcinoma and not lymphoma.

PET scan is suggestive of bony metastatic lesion too. So it's a stage 4 disease. Depending upon his activity level if he is fit and fine with no co-morbid illness, combined treatment with androgen blockade(orchidectomy) plus chemotherapy(docetaxel) will provide the maximal survival benefit.

It's a slow growing tumor and after first line, we have other lines of treatment too

Thanks and regards

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Above answer was peer-reviewed by : Dr. Arnab Banerjee