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Q. Kindly explain the TRUS guided prostate biopsy report and further treatment.

Answered by
Dr. Raguram Ganesamoni
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 15, 2018

Hi doctor,

The patient is a 59-year-old male with whose weight is 52.3 kg and height is 166 cm. His PSA was 247.5. He had a TRUS guided biopsy, and the report is as follows.

1. Moderately differentiated adenocarcinoma.2. Gleason grade 4+4.3. Perineural invasion present.

What does the biopsy report say? What will be the next step? What medicine should the patient take at the initial stage before any surgery? The patient is on Tamdura for the prostate issue and Diamicron MR 30 for diabetes.

Dr. Raguram Ganesamoni

Andrology Urology


Welcome to

I am sorry to know about the problem. The biopsy report says that prostate has a cancer disease. Since PSA is very high, it means that there is a chance that it has spread outside the prostate.

The next step will be PSMA PET scan to find out the areas in the body affected by prostate cancer. If this scan is not available, you can get an MRI scan of the abdomen to check local involvement or lymph node involvement along with bone scan to find out bone metastasis.

The treatment depends on the stage of disease. If it has spread to bones, then bilateral orchidectomy (removal of testes) is the standard treatment. If the patient does not want orchidectomy, then can get regular injections (once in 3 months) to suppress the testicular function. The patient should also take injection Zoledronic acid once in every 3-4 weeks to control bone spread. Other than these, there is a need for calcium supplements and iron supplements.

Please consult the Urologist for regular follow up, since the treatment needs to be modified according to the response of PSA and clinical factors.

Investigations to be done:

PSMA PET scan or MRI abdomen with bone scan.

Probable diagnosis:

Metastatic carcinoma prostate.

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