Adenocarcinoma Case Study
Consulting Physician: , M.D.
Identification Statement: is a year old male diagnosed with a pathologic T stage N stage, Gleason score (3+3, 3+4, 4+3, 5+3, 5+4, 5+5) Group (I, IIA, IIB, III, or IV) adenocarcinoma of the prostate
History of Present Illness: The patient was seen in consultation at the request of [requesting MD]. initially presented with an abnormal PSA. PSA was found to be (blank) on (date). He also presented with increased urinary frequency and urgency. His IPSS score was (blank). His SHIM score was (blank). In the past he has/has not had a TURP.
On (date), Mr. underwent a prostate biopsy. Pathology was consistent with adenocarcinoma of the prostate. Adenocarcinoma of the prostate was seen in (blank/blank) …show more content…
[He or she] is (alone or accompanied by). He is alert and oriented x 3.
HEENT: EOMI, PERRLA. The oropharynx is clear. There are no lesions seen.
NECK: The neck is supple. There is no evidence of thyromegaly.
Lymphatics: There is no palpable cervical or supraclavicular lymphadenopathy noted.
Lungs: Clear to auscultation bilaterally. There are no wheezes, rhonchi, or rales.
Cardiovascular: Regular rate and rhythm. No murmurs, rubs, or gallops.
Abdominal: Soft, nontender, nondistended. Positive bowel sounds. There are no palpable masses.
Rectal: Sphincter tone within normal limits. There are no palpable masses or nodularity noted in the prostate bed. There was no blood on the examination finger
Extremities: No cyanosis, clubbing, or edema.
Neurological: Cranial nerves II-XII intact. There are no focal sensory or motor losses noted in the upper or lower extremities bilaterally. Gait was within normal limits. Musculoskeletal: There is no spinal or CVA tenderness noted.
Labs:
Pertinent Imaging Studies:
[imaging modality][date]-
[imaging modality][date] …show more content…
Plan: We have discussed the role of radiotherapy in the management of his disease. Over 60 minutes were spent with the patient, over half of which was performed counseling the patient regarding the treatments and side effects of radiation therapy. Based upon the pathology of his prostate cancer he would benefit from radiotherapy.
The recommendation for adjuvant radiation therapy is based on randomized controlled trials by SWOG S8794 and EORTC 22911, both of which randomized patients with pathologic T3 disease or positive margins to adjuvant radiation vs observation. At 12 years, the SWOG study demonstrated that adjuvant radiation decreased the percentage of patients with metastases or death from 54% to 43%, improved metastases free survival from 12.9 years to 14.7 years (HR 0.71 95% CI 0.54-0.94), and overall survival from 13.3 years to 15.2 years (HR 0.72 95% CI 0.55-0.96).
Per Stephenson, we estimate that the rate of success for salvage radiation therapy is ???? based on this patients pre radiation PSA of , Gleason score of , +/- margin status, estimated PSA doubling time of
Identification Statement: is a year old male diagnosed with a pathologic T stage N stage, Gleason score (3+3, 3+4, 4+3, 5+3, 5+4, 5+5) Group (I, IIA, IIB, III, or IV) adenocarcinoma of the prostate
History of Present Illness: The patient was seen in consultation at the request of [requesting MD]. initially presented with an abnormal PSA. PSA was found to be (blank) on (date). He also presented with increased urinary frequency and urgency. His IPSS score was (blank). His SHIM score was (blank). In the past he has/has not had a TURP.
On (date), Mr. underwent a prostate biopsy. Pathology was consistent with adenocarcinoma of the prostate. Adenocarcinoma of the prostate was seen in (blank/blank) …show more content…
[He or she] is (alone or accompanied by). He is alert and oriented x 3.
HEENT: EOMI, PERRLA. The oropharynx is clear. There are no lesions seen.
NECK: The neck is supple. There is no evidence of thyromegaly.
Lymphatics: There is no palpable cervical or supraclavicular lymphadenopathy noted.
Lungs: Clear to auscultation bilaterally. There are no wheezes, rhonchi, or rales.
Cardiovascular: Regular rate and rhythm. No murmurs, rubs, or gallops.
Abdominal: Soft, nontender, nondistended. Positive bowel sounds. There are no palpable masses.
Rectal: Sphincter tone within normal limits. There are no palpable masses or nodularity noted in the prostate bed. There was no blood on the examination finger
Extremities: No cyanosis, clubbing, or edema.
Neurological: Cranial nerves II-XII intact. There are no focal sensory or motor losses noted in the upper or lower extremities bilaterally. Gait was within normal limits. Musculoskeletal: There is no spinal or CVA tenderness noted.
Labs:
Pertinent Imaging Studies:
[imaging modality][date]-
[imaging modality][date] …show more content…
Plan: We have discussed the role of radiotherapy in the management of his disease. Over 60 minutes were spent with the patient, over half of which was performed counseling the patient regarding the treatments and side effects of radiation therapy. Based upon the pathology of his prostate cancer he would benefit from radiotherapy.
The recommendation for adjuvant radiation therapy is based on randomized controlled trials by SWOG S8794 and EORTC 22911, both of which randomized patients with pathologic T3 disease or positive margins to adjuvant radiation vs observation. At 12 years, the SWOG study demonstrated that adjuvant radiation decreased the percentage of patients with metastases or death from 54% to 43%, improved metastases free survival from 12.9 years to 14.7 years (HR 0.71 95% CI 0.54-0.94), and overall survival from 13.3 years to 15.2 years (HR 0.72 95% CI 0.55-0.96).
Per Stephenson, we estimate that the rate of success for salvage radiation therapy is ???? based on this patients pre radiation PSA of , Gleason score of , +/- margin status, estimated PSA doubling time of