Surgery Risks for Prostate Tumors: A Family's Dilemma

Magnetic resonance imaging (MRI) revealed a 7 cm tumor located in the posterior superior region of the prostate. What are the success rates of surgery and the postoperative recovery process?

Hello Dr.
Hsu,
Due to the severe pandemic situation, it is inconvenient for me to return to Taiwan, so I have to ask my question here.
I sincerely appreciate your taking the time to read this.
My father-in-law recently underwent an annual health check-up, which revealed a suspected tumor behind the prostate.
Initially, there were concerns about prostate cancer or colon cancer, but blood tests, urine tests, and stool tests all returned normal results.
Eventually, an MRI showed a 6.3 cm x 8.6 cm sarcoma located above the prostate.
The doctor advised us to "arrange for surgical removal as soon as possible." However, my father-in-law is currently in very good health and feels completely fine.
We are worried about the risks of surgery (the doctor mentioned it would be an abdominal procedure).
I also found online that if the sarcoma is malignant, it seems to be more complicated than regular prostate cancer, with fewer cases surviving more than one year after diagnosis.
As family members, we are truly distressed and feel caught in a dilemma.

Could it be that the tumor's size is why the doctor did not recommend a biopsy? Is the risk of this surgical removal very high? Are there other factors that need to be evaluated? Below is the MRI report for your reference:
"The bladder is well distended, and the bladder wall is smooth.
No significant abnormal signals are observed internally.
The prostate's shape is normal, with a volume of approximately 4.2 cm x 2.4 cm x 3.3 cm.
The peripheral zone and central zone are clearly defined, and no significant abnormal signals are seen on T2W1.
No significant high signal is observed on DW1.
A lobulated cystic-solid signal is seen in the posterior superior aspect of the prostate, primarily showing short T1 and long T2 signals, with high signal on DW1, and significant enhancement after contrast, measuring approximately 6.3 cm x 8.6 cm.
The enhancing capsule wall and solid nodules are visible, with pressure and displacement of the left seminal vesicle.
The structure of the rectal wall is normal, with no enlarged lymph nodes observed."
Preliminary diagnosis: Cystic-solid mass in the posterior superior aspect of the prostate, sarcoma pending removal.
Thank you very much for your time and response.
Wishing you good health and all the best!

Lu, 50~59 year old female. Ask Date: 2020/12/29

Dr. Xu Wencang reply Urology

Sarcoma is primarily treated with complete surgical resection.
The prognosis is related to the degree of malignancy and whether it can be completely excised.
If the patient's overall condition permits, surgery is still recommended.
Biopsy is not suitable for sarcoma.

Reply Date: 2020/12/29

More Info

Dear [Name],
Thank you for reaching out with your concerns regarding your father-in-law's recent diagnosis and the potential surgery for the suspected sarcoma located near the prostate. I understand that this is a challenging time for your family, especially given the uncertainties surrounding the diagnosis and the implications of surgery.

First, it’s important to clarify the nature of the tumor. Sarcomas are a type of cancer that arises from connective tissues, such as muscle, fat, or bone, and they can behave differently than carcinomas, which are cancers that originate in epithelial tissues, such as the prostate gland. The size of the tumor you mentioned (6.3 cm x 8.6 cm) is significant, and larger tumors can sometimes present more complex challenges in terms of treatment and prognosis.

Regarding the decision not to perform a biopsy prior to surgery, this can be a common practice in certain cases, especially when the imaging studies (like MRI) suggest a high likelihood of malignancy, or when the tumor is large and the risks of a biopsy may outweigh the benefits. In this case, the MRI findings indicate a cystic-solid mass that is concerning for malignancy, which may have influenced the decision to proceed directly to surgical intervention.

As for the risks associated with the surgery, any surgical procedure carries inherent risks, including infection, bleeding, and complications related to anesthesia. Given that the surgery is planned to be performed through an abdominal approach, there may be additional risks related to the organs in the abdominal cavity. However, if the surgical team deems that the benefits of removing the tumor outweigh these risks, it is likely because they believe that the tumor poses a greater threat if left untreated.

In terms of recovery, sarcomas can indeed have a different recovery trajectory compared to more common prostate cancers. The prognosis for sarcomas can vary widely based on factors such as the tumor's grade (how aggressive it appears under the microscope), size, and whether it has spread to other areas of the body. If the tumor is found to be malignant, the surgical team may recommend additional treatments, such as chemotherapy or radiation therapy, depending on the specific characteristics of the tumor.

It is also essential to consider your father-in-law's overall health. If he is otherwise healthy and asymptomatic, this may positively influence his ability to tolerate surgery and recover well. However, it is crucial to have a thorough discussion with the surgical team about the potential risks and benefits of the procedure, as well as any alternative management strategies that may be available.

In conclusion, while the decision to proceed with surgery can be daunting, it is often made with careful consideration of the risks and potential outcomes. I encourage you to have an open dialogue with the healthcare providers involved in your father-in-law's care. They can provide more personalized insights based on his specific situation and the latest medical evidence.
Thank you for your thoughtful questions, and I wish you and your family the best as you navigate this difficult time. Please feel free to reach out if you have further questions or need additional information.

Best regards,
Doctor Q&A Teams

Similar Q&A

Surgical Options for Dementia Patients with Prostate Issues: A Family's Dilemma

My grandfather is 74 years old and has dementia (he does not exhibit violent tendencies but has difficulty with verbal expression). He recently underwent hernia surgery and currently has benign prostatic hyperplasia, for which he has a urinary catheter in place. He has been expre...

Dr. Tu Xiuhong reply Urology
Difficulties in urination and urinary retention are not necessarily caused by benign prostatic hyperplasia; elderly individuals may experience urination difficulties due to brain lesions as well. It is advisable to seek examination at a major hospital. Dr. Tu Hsiu-Hung.

Understanding Prostate Cysts: Surgical Risks and Treatment Options for Seniors

Hello, doctor. My father is 87 years old, and during a recent health check-up, it was found that he has cysts on his prostate. The doctor mentioned that surgery is necessary, but I am concerned about the risks associated with surgery at his age. I would like to know if surgery is...

Dr. Lin Wenxu reply Urology
Hello, sorry, but what type of surgery does your father need? What are his urinary symptoms? What is his PSA level? I suggest you discuss with the physician to understand why surgery is necessary and how it will be performed. You may also seek opinions from both doctors; if their...

Managing Prostate Cancer in Elderly Patients: A Guide for Families

Hello, Dr. Hsu: My father is 81 years old and has recently experienced frequent urination with a prickling and burning sensation in his lower abdomen. He underwent an ultrasound examination at the hospital, which showed that his prostate is enlarged and his urine flow rate is ver...

Dr. Xu Weikai reply Urology
Mr. Gao: Hello, actually, whether to perform a biopsy or even whether to proceed with treatment should depend on the opinions of the patient and their family. Age is a consideration, but it is not the only factor. Let me first outline my general principles: 1. For patients under ...

Prostate Cancer Treatment: Radiation vs. Surgery - Which is Better?

Hello, my father is 61 years old and was recently diagnosed with prostate cancer. The doctor recommended radiation therapy, but I have read reports suggesting that surgical treatment is preferable. Which method is better, and which has fewer side effects or complications?

Dr. Chen Sirong reply Oncology
Hello: 1. I personally recommend radiation therapy as it has fewer side effects; after treatment, monitoring PSA levels and taking oral hormone therapy would suffice. 2. However, surgery is definitive; the advantage is that the tumor is immediately removed, but my friend's f...