How do you handle risk stratifying and radiation treatment in a patient with concurrent MRI diagnosed asymptomatic prostatitis and prostate cancer diagnosis?
How reliable is MRI only diagnosis of prostatitis? Assume no prior PSA and Group grade 2 or 3. Would you treat prostatitis? How do you deal with ADT especially if PSA is >20? What are your fields and fractionation?
Answer from: Radiation Oncologist at Academic Institution
My concern, in this case, is that whatever has been uncovered by the MRI might be artificially elevating the PSA, which might result in erroneously classifying the patient into a higher risk category, leading to more treatment than is necessary. Personally, I have never seen a clinically significant...
Answer from: Radiation Oncologist at Academic Institution
I don’t recall encountering this situation. If described by the diagnostic radiologist and is symptomatic, antibiotics for a month and repeat the MR and PSA. I don’t think that they would likely change. That said, I’m often wrong!
Answer from: Radiation Oncologist at Community Practice
I would stage the patient per usual based on Gleason Score and staging workup and plan on treatment accordingly. I would also try to identify the cause of prostatitis since if the patient desires radiation treatment, my experience has been that these patients have more bothersome voiding symptoms. M...