Healthy, active 87 year old with Gleason 8(4+4) 2/12 PSA 29. Treat or not?

My father a healthy 87 year old just got biopsy results Gleason score 8 (4/4) in 2 of 12 lobes. Bone scan clear...waiting on CT scan results. PSA 29. Would you recommend treatment? Dr. suggesting radiation which I think could challenge quality of life. He is not in any pain and feels fine. Advice? Thank you for your time

Gave your thread a subject. Welcome to the forum! -- PeterDisAbelard

Post Edited By Moderator (PeterDisAbelard.) : 10/4/2016 12:13:59 AM (GMT-6)

Lube -

Your Dad is feeling no discomfort - I agree with alephnull--

Bobby Mac

I suggest he fill out the following, which may give him some perspective:

Probability of dying from prostate cancer vs other causes if left untreated

A lot depends on his "physiological age" not just his "chronological age." It mostly depends upon what he prefers to do.

"Watchful Waiting" means there is no intention to treat it, just to have palliative treatments, like hormone therapy or spot radiation to bones, if symptoms (like pain) develop.

Another option is starting on hormone therapy right away. A 92-year-old man in my support group takes one 50-mg Casodex pill every day. He has some hot flashes, which for him are manageable. His PSA is low and steady. A stronger kind of hormone therapy include chemical castration (shots every 4-6 months). I don't know if orchiectomy is feasible without full anesthesia.

Another option is treatment with SBRT (5 external beam radiation treatments). An 80-y.o. man in my support group opted for this. He's had no symptoms of treatment. He proudly tells us that his erectile function remains excellent. He had the typical irritative urinary and rectal symptoms that went away after a couple of weeks. Of course, that's just one man. Others may be troubled with those symptoms for longer. There is little to no fatigue associated with these short treatment regimens. In general, older men recover more slowly from radiation.

I'd follow Tall Allen's advice and use the tool for life expectancy.

" older men recover more slowly from radiation". I'd wager most of them....and possibly for the rest of their lives. ADT...seems like that might be since they probably don't have much "A" to be deprived of.

Thank you all for your advice and sharing of your experiences. I am so grateful to have found this site. My dads Ct scan results came back negative! Just has the cancer in the two lobes of prostate. (G8, psa 29) Not sure what will happen now. He is so healthy and active(rides bike and goes to the gym 3 days a week). I am skeptical of messing with his quality of life. I appreciate any feedback and thank you again for welcoming me on this forum.

Probably not at 87 years of age ,Andrew

Fair enough, no real problems no matter what age if there are no comorbidities for any treatment, and probably more than 10years expectant life, there are exceptions of course but not significant as I read it.
Not me ,though, if I'm 87 years old and feeling OK and have PCa I ain't doing nothing. I doubt I'll live that long anyway let alone 97. At 67 you might charitably say I am feelin' it. Slow recovery from any injury, soreness after a day's work and more fatigue..all that stuff...I don't want to chance feeling worse . I wouldn't mind living longer but wouldn't want to make it just feel like it and really am not.

But then I have an inordinate dislike of things like cystitis, proctitis, urinary and fecal incontinence and the like..even if it is "only"for a few months and possibly much longer.

I would consult with the best Radiation Oncologist I could find and get his views about side effects and advanced age...I'm 74 years, Gleason 9 and I've had all 3 major treatments..Surgery, Radiation and ADT..I've had no mentionable side-effects from the radiation. The ADT carries the biggest side-effect load..Hot flashes, loss of sex drive and ability, loss of most of your body hair..You should ask to have his testosterone level tested now just to see where it is..From this, you may be able to get an idea of how bad an experience ADT might be..(the higher the fall, the worse it hurts when you hit the ground..)

I feel that having aggressive treatment applied against my aggressive cancer has extended (and continues to extend) my life well past what it would have been had i opted to "just let it go".......But yes, there is a point where the quality of life issues overrule any benefit that aggressive treatment might bring..

Lube, it's great he has you to at least raise the question and consider all and not just rush into treatment. Of course as others have said ultimately only he can decide. Just the stress of knowing he has cancer at 87 would be difficult for most so my view is treating would be hard and not treating will still be tough. The worry of whether it is progressing faster then hoped is tough on anyone at any age. If his gleason was lower the choice not to treat would for sure be less difficult. If he were to go with treatment for sure I would agree with TA:

"Another option is treatment with SBRT (5 external beam radiation treatments). An 80-y.o. man in my support group opted for this. He's had no symptoms of treatment. He proudly tells us that his erectile function remains excellent. He had the typical irritative urinary and rectal symptoms that went away after a couple of weeks. Of course, that's just one man. Others may be troubled with those symptoms for longer. There is little to no fatigue associated with these short treatment regimens. In general, older men recover more slowly from radiation."

My girlfriend's friend's Dad was diagnosed at just about 80 years old, not sure of the diagnosis but I do believe it was low or intermediate risk. His son, around 52 years old was diagnosed around the same time. The son chose surgery and the dad was only given the option of radiation. He was mad because he wanted surgery and could not understand why he wasn't given that option. Eventually he had the short term HT with the 9 weeks of radiation. He also was very active, still skis; they had to drag him out of work to retire a short time before. His main complaint after the radiation (late last year) is he is more fatigued. He still does what he needs to do and likes to do but is more tired.

Is it just being a year older or the radiation, who knows? We'll all get tired eventually. Maybe as TA said the 5 treatments of radiation would have been better at his age and less fatigue. Was the HT really needed at his age with the radiation?

But I fully understand why you would not want to mess with his QOL when he has been doing so well. But in my opinion his QOL has already been messed with just by the diagnosis. It might have been better for him to not have had the PSA at 87 but it's too late for that.

Either way your Dad has a very difficult choice. I hope whatever he chooses works out great for him and you and the family. I'm sure it will be hard for him trying to please everyone with whatever he chooses...Jim

I suggest the responsible thing to do is to get the best assessments and treatment options from the very best doctors in the area. Many great thoughts have been advanced here and should help Lube and his father in the research.

My brother in law had IGRT at age 77 and has done very well four years later. SBRT or even HDR brachytherapy would be even less significant than 30 or so IGRT sessions.

My father had bad arthritis in his knees and in his early 80's he considered replacement, but was talked out of it because of the problems recovering from the surgery. He complained for the rest of his life that the recovery would have been much better then the daily degeneration and pain he endured.......until passing away at age 93.

I am concerned about the G8 and 29 PSA. This could get out of hand quickly as Peter stated. Moderate treatment now will likely be less a QOL issue than battling bone mets in a couple of years.

Lube, as JNF said, get to the best place and people you can. Where are you (and more importantly he) located? Perhaps someone here has experience in that area and can steer him on a good path. Regardless, you can't go wrong in any of the NCCN centers of excellence (in the US). There is one within a reasonable travel distance to just about everyone in the country.