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54-year-old man had trouble urinating for several months. Rectal: Enlarged, hard asymmetrical prostate, with nodule present in right lobe.
Pelvic CT scan: Negative for mets.
Bone scan: No mets; arthritis only.
See surgical findings.
Cystourethroscopy and TURP: Tumor extended from the anterior lobe of the prostate and extended to the bladder neck and bladder wall; also extended all the way out to the verumontanum. There is concern for capsular involvement. Radical retropubic prostatectomy not advised due to severe respiratory disease.
Gross: Biopsies of bladder neck, bladder wall, and prostate. Micro: Extensive poorly diff adenoca, Gleason 4+4 = 8 of the prostate gland; also involves the bladder neck and the bladder wall.
Hormone: Lupron injection
Radiation: Beam radiation to prostate and seminal vesicles 4500 cGy 5 field IMRT 6MV, boost to prostate 3060 cGy 5 field IMRT 6MV