Time for a biopsy?

My 78 y.o. father has been 'watchful waiting'.  He called last night with the results of his latest PSA.  Which has been slowly but steadily rising.  Up to 8.5 from 8.0 about a year ago.  GP says time to talk to Urologist (with the intention, I'm sure of getting a biopsy).

He's pretty resistant to biopsy (I may have tainted him some with 'colorful' stories of my own ordeal). 

At his age and current PSA / velocity, how critical do you think it is to get Gleason type information to make decisions?  Other thoughts?

Edit - I should add that he's a 'young' 78 -- i.e. still pretty active and able.  Last year he was one of my three man crew for a sailing trip around the Delaware-Maryland-Virginia (DelMarVa) peninsula with ovenight watches on the ocean side, etc.  Pretty good, I think, at that age.

 

Post Edited (Rolerbe) : 2/17/2011 9:49:27 AM (GMT-7)

Not sure there is point at his age, PC is a slow growing cancer. He can if he wishes but I'm not sure they will do anything if they find it.

I agree it's a tough call. His health, apart from CABG (quadruple bypass) and a series of Stent's is pretty good. Could probably use a knee replace in one, but he gets Cortisone shots every 6 mos or so which help out.

I guess I would lean towards doing the biopsy. If Gleason 7 or above, then maybe seeds. From JAMA 1998; 280 and article called "Competing Risk Analysis of Men Aged 55 to 74 Years at Diagnosis Managed Conservatively for Clinically Localized Prostate Cancer", the 15 year mortality risk for 70-74 yo's, specific to PCa, was about 40%, and about equal to the risk from all other causes. That's still a lot of area under the curve.

"Managed Conservatively" meant no surgery or radiation of any form, but harmone therapies for some of the patients at some point in the progression.

Here's a link to the article I cited:  http://jama.ama-assn.org/content/280/11/975.full.pdf

John,  you may be right.  Hard for me to tell whose demons I'd be chasing, his, or my own.

Totally agree-the side-effects and decline in quality of life will make him regret the day he ever agreed to a biopsy and subsequent treatment- whether surgery, radiation or any other. Given his age it is highly unlikely that he will die from prostate cancer in my opinion.

Don't do it.

JohnT, that sounded cold in your last post. The man might be 78, but sounds in good health, he may live to be a 100, another 22 years from now. He may have PC, and it may be treatable in a way that makes sense to his age/health. It may have some bad PC, and knowing about it is not a bad thing. Might still be able to help him, or suffer less in the future. I believe every life is equally important, and I am not going to write someone off because they are 78. Thought we strongly believed in testing around here, and what happened to "not knowing" is not good medical advice?

David in SC

Rolerebe.

If your dad is "pretty resistant" to a biopsy at his age(and I don't blame him) why are you pressuring him to maybe have one. ? His quality of life appears to be fine why would you want him to possibly suffer possible radical treatments, incontinence, months of pads or maybe a lifetime of them. He's 78 for gods sake let him make his own decision. The modest gain in PSA at his age wouldn't be a cause for my concern if it was my dad. Not at all.

The chart you bring from 1998 is really ancient as far as studies go. I'm sure someone else will link to to a much newer and more optimistic realistic 21st century graph

Dave he may be 78 and he could live to be 100 but most likely he won't. Even if he does I still bet something else will end his life before PCa. He's 78 not 58

Ziggy, I haven't actually been pressuring him at all, we've only had one conversation.  His 'resistance' is just the natural distaste when considering a procedure for the first time.  I'm not sure he should have it done either. 

I do think he should have a visit with a Uro to ask the essential question that Fairwind raised.  But I've found it best to do the research and go prepared.  So, I'm updating my info and gathering opinions to discuss intelligently.  Thanks to all for the replies.