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Advice and options available for patients diagnosed with Protastatic Carcinoma
under the care of Mr H Lewi, FRCS

As you know your protastatic biopsies have, unfortunately, confirmed protastatic carcinoma. I would recommend that treatment should be aimed towards providing a cure rather than palliative treatment.

There are four options available to you as follows:

1. We can do nothing and merely observe your progress.

2. Commence some form of anti-androgen (anti-testosterone) therapy which may inhibit the prostate cancer for a period of time.

3. Radical radiotherapy to the prostate itself with its inherent problems of developing a small, contracted bladder, erectile failure and the possibility that this may not completely eradicate the prostate tumour. We would therefore have to carefully monitor your progress.

4. Radical prostatectomy which would be carried out as a curative procedure.
It should be noted that radical prostatectomy is associated with significant incidence of erectile dysfunction following surgery and a 10% incidence of incontinence.

The way forward is to consider some form of curative procedure and radical prostatectomy, although carrying the post-operative problem of erectile dysfunction, is significant as a curative operation. There are therapies available to reverse and correct post-operative erectile failure.

Initially, further staging investigations would be arranged, including an MRI scan and bone scan which are part and parcel of the work up towards a radical prostatectomy. These are specifically looking for changes in the skeletal structure which can be altered by the prostate tumour.

If you wish to discuss the matter further at any time, do not hesitate to contact Mr Lewi.

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