Prostate Cancer Metastasis and Treatment Options

Prostate cancer metastasis?

Hello Dr.
Du, my father was diagnosed with T3A prostate cancer this year and has recently undergone a Da Vinci robotic-assisted radical prostatectomy.
However, he experienced urethral stricture and had to undergo another endoscopic procedure.
Recently, his PSA level has risen to 1.85, and his treating physician has recommended starting radiation therapy.
He previously had an MRI, and the physician indicated that the imaging did not show any signs of recurrence; however, due to the rising PSA levels, they suggested proceeding with radiation therapy.
I would like to ask Dr.
Du if lymphatic, organ, or bone metastases can be detected through MRI imaging.
My father occasionally mentions some discomfort in his lower back, and given the significant increase in his PSA levels, we are quite concerned.
I appreciate your insights on this matter, thank you!
Additionally, I would like to inquire if you have encountered cases where prostate biopsy procedures have resulted in nerve damage.
Since my father's biopsy, he has been unable to sit for extended periods.
After consulting a neurologist and receiving medication, he has gradually improved, but due to the urethral stricture and the use of a dilator, he has started to experience difficulty sitting again.
This situation is quite distressing, and I would appreciate your response, thank you!

Ms. Chen, 30~39 year old female. Ask Date: 2018/12/29

Dr. Du Mingyi reply Urology

1.
Magnetic resonance imaging (MRI) can be used to assess lymph node metastasis, while bone metastasis is evaluated using a bone scan.

2.
During surgery, there is a possibility of injuring nearby nerves; however, this is usually related to urinary incontinence and sexual function, and should not be associated with prolonged sitting.

Reply Date: 2018/12/29

More Info

Understanding prostate cancer, particularly in the context of metastasis and treatment options, is crucial for patients and their families. Your father's case, diagnosed with T3A prostate cancer and having undergone a Da Vinci robotic-assisted radical prostatectomy, presents several important considerations regarding his ongoing treatment and monitoring.

Prostate Cancer Staging and Monitoring
Prostate cancer is staged using the TNM system, where "T" refers to the size and extent of the primary tumor, "N" indicates whether the cancer has spread to nearby lymph nodes, and "M" denotes whether there are distant metastases. In your father's case, T3A indicates that the cancer has extended beyond the prostate capsule but has not invaded nearby structures. The rise in PSA (Prostate-Specific Antigen) levels post-surgery is concerning, as it may indicate residual cancer cells or recurrence.

Imaging and Detection of Metastasis
Magnetic Resonance Imaging (MRI) is a valuable tool in assessing prostate cancer, particularly for detecting local recurrence and evaluating lymph node involvement. However, while MRI can provide detailed images of soft tissues, it may not always detect small metastases, especially in bones or distant organs. If there are concerns about bone metastasis, a bone scan or PET scan may be recommended, as these imaging modalities are more sensitive to changes in bone structure associated with metastatic disease.

Your father's occasional complaints of back discomfort could be related to several factors, including post-surgical changes, nerve irritation, or potential metastatic involvement. It is essential to communicate these symptoms to his healthcare team, as they may warrant further investigation.

Treatment Options
Given the rising PSA levels, your father's oncologist has suggested radiation therapy. This is a common approach for patients with biochemical recurrence (elevated PSA levels) after surgery. Radiation therapy can help target any remaining cancer cells in the prostate bed and surrounding tissues. The decision to proceed with radiation is typically based on the PSA trend, imaging results, and overall health status.

Nerve Injury and Complications
Regarding your concern about nerve injury from the prostate biopsy, it is possible for complications to arise from such procedures. While rare, nerve damage can occur, leading to symptoms such as pain or discomfort in the pelvic region. If your father is experiencing significant discomfort that affects his quality of life, it is crucial to discuss this with his healthcare provider. They may consider pain management strategies or further evaluation to address these symptoms.

Conclusion
In summary, your father's situation requires close monitoring and a multidisciplinary approach to treatment. The rise in PSA levels post-surgery is a signal for further evaluation and potential intervention, such as radiation therapy. While MRI is a useful tool, it may not provide a complete picture of metastatic disease, and additional imaging may be necessary. Communication with his healthcare team about symptoms and concerns is vital for ensuring the best possible care and management of his condition.
If you have further questions or concerns, do not hesitate to reach out to his medical team for clarification and support. They can provide personalized guidance based on his specific circumstances and treatment plan.

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