Woods & Water Medical Center

1019 S. Knowles Avenue • New Richmond, WI • 54017 • 715.246.6561 • www.wwcm@world.com

May 8, 2019

Alice Conklin, MD
435 Michigan Avenue
Hillsdale, MI 49242-3212

Dear Dr. Conklin:

RE: Joseph L. Vargas

DOB: 09/20/1964

Mr. Vargas is a 54 year old male seen because of recently diagnosed prostate cancer. Three years ago
he had a PSA 7.1. An ultrasound was suggested, but the patient did not have it performed. His brother
has a history of prostate cancer and had previous radiation therapy followed by a salvage
cystoprostatectomy and orthotopic neobladder.

Approximately two years ago, in May 2017, Mr. Vargas had a PSA of 15.7 and ultrasound revealed a 2.5
cm hypoechoic area that was biopsied and showed a Gleason score of 7 carcinoma. Perineural invasion
was noted on the right side involving 50% of the tissue with a Gleason score of 7 carcinoma. On the left
side, the biopsy showed 70% of the core involved for a Gleason score of 7. The patient has been cared
for by you and a radical prostatectomy was advised; and he was given a 3-month depot shot of Lupron
on May 9, 1998. Bone scan was negative with arthritic changes in L5. He had no significant urinary
symptoms prior to the diagnosis and there has not been any appreciable change since being on the
endocrine therapy. Medications include Hytrin, Ativan, and Lupron. He has had adverse reactions in
the past to SULFA and BETADINE.

Previous surgery includes a fibroid tumor in the small bowel and later a small-bowel obstruction. He
also has a history of hypertension. No cigarette or alcohol use is noted. Family history is significant in
that both his father and brother have had prostate cancer.

PHYSICAL EXAM: Abdomen shows no mass. Penis and testicles are normal. Rectal exam shows a 15-20
g prostate that is symmetrical without nodularity or induration.

IMPRESSION: Carcinoma of the prostate, clinical stage T2cNxMo.

STUDIES ORDERED: Outside slides submitted today for review.

Alice Conklin, MD
February 21, 2019
Page 2

TREATMENT: Treatment options were reviewed at length with the patient and his wife; and they were
given written information on all of the options and complications. The options discussed included
observation, surgery, radiation therapy, and alternate treatments such as implant radiation and
cryosurgery. He would clearly not be suited for observation. My bias would be toward a radical
prostatectomy. He was advised that consultation with a radiation oncologist would be very reasonable.
The patient is interested in possibly receiving another shot of Lupron and delaying the treatment for
another 3 months; and I do not think there is any risk associated with this. It is possible he could have a
nerve-sparing dissection done on 1 side, but that may not be feasible because of the disease and
because of his hormonal therapy. The risks of incontinence were discussed in detail.

Sincerely yours,

Mark Hubbard, MD
Oncology Department

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