76 year old rising healthy PSA. What to do?

My first reaction: "Get a new URO, one who's willing to listen to your concerns."

It's possible your friend will out live all of us. A healthy 71 year-old could live 20 or more years.

In the absence of other symptoms, I'd be concerned about that PSA. More tests would be reasonable - PHI might provide more information. If the URO wasn't obsessed with age, considering a biopsy wouldn't be unreasonable.

Andrew

I agree that if your friend does not feel the URO is listening to him, get a new URO.

My Dad is over 90--so at 76, there are likely at least 15 years ahead of him. While he may choose to do nothing, he cannot make an informed decision without knowing the facts. The URO needs to look into the rising PSA, then informed choices and decisions can be made.

Most of us are able make reasonable opinions for hypothetical individuals based in statistics. It is when we apply this reasoning to a real case when we doubt. We know his PSA rising may probably indicate that there is something serious going out and we know that treatment for PCa is often dangerous and useless at his age. Therefore, it is hard to advice. I guess it is the advice of medical professionalswhat he should hear. They are used to decide in these cases. Although they also may be right or err, this is exactly for what they are suposed to be trained.

I agree with you Jim. We can not uniformly treat all men in their 70's as no need to treat.

Paul

here's an interesting article lamenting Warren Buffet's decision to be treated for prostate cancer at 81 (2012). the writer thinks old guys should stick their head in the sand and not be tested so other old guys will do the same because most will die of something else first. I bet the Oracle of Omaha would have laughed in his face!

my advice to your friend is to get another doctor.

https://www.health.harvard.edu/blog/buffetts-prostate-cancer-poor-decisions-201204234621

as a follow up to the Buffet article here's a comment that was made back in 2012 that perfectly sums up my beliefs on PSA testing, which I believe should be performed annually beginning at age 40,


>>George MacDonald


Pretty much everything expressed in this article is a matter of opinion and up for debate.

So, it befuddles me that a medical professional would be telling people NOT to have a test (such as PSA) that carries no risk.

The problem is NOT with the test — it is with what other physicians do with the results. If Buffet was informed of all his options and the consequences and/or benefits associated with each — HE was making an informed choice. HIS choice.

The choice should not lie with a physician. It is Buffet’s prostate not the physician’s. It is Buffet’s choice.

True, when somebody else is paying a test, it can be argued that the cost of the test outweigh any likely benefits from the test. But, Buffet could afford to pay for a PSA test for pretty much evey man in the country — so that was not a factor in this case.<<

JNF:

Your friend does not need a urologist. He needs a truly expert diagnostic radiologist to perform and analyze a 3TESLA multi-parametric MRI.

If he is near you in Georgia, I recommend that he check out Dr. Joseph Busch at the Chattanooga Outpatient Center of Diagnostic Radiology Consultants in Chattanooga, Tennessee.

JNF your friends sounds like he is on top of it. Buffet is smart and it is odd that a Havard Medical School physician would question his decision. The statement in the article is somewhat self-serving quoting their own report. "Although quite safe, radiation therapy isn’t a risk-free procedure. As we describe in Harvard Medical School’s 2012 Annual Report on Prostate Diseases, it has immediate side effects, such as fatigue and bowel problems. By 2017, with fewer men being detected with early-stage prostate cancer and with the rise in advance prostate cancer incidences, the task force determined that men ages 55 to 69 should make an individual decision about the PSA screening with their clinician, but men over 70 should not be tested.
However, the recommendation to exclude older men from the PSA screening was not universally accepted.
“There is increasing evidence that this age-based approach is significantly flawed,” said Patrick Walsh, an internationally renowned professor of urology at Johns Hopkins School of Medicine, who co-authored a recent study on high-risk prostate cancer in older men. According to the John Hopkins investigators, men age 75 and older account for 48 percent of metastatic cancers and 53 percent of the deaths from prostate cancer. Without PSA testing, cancer can go undetected, limiting treatment options. My father, who is 93, was successfully treated for prostate cancer at age 78 with both hormones and radiation by the VA. If he needs treatment he should get treatment if he qualifies of active surveillance even better.

68 yrs., marathon runner, 25 of 44 3D-CRT/IMRT Radiation delivered via 3D-CRT in 1.8 Gy minimum dose fractions to a total of 79.2 Gy., 10.5.18. PSA .012, 8.12.18, 1.42 June 18, 2018 (Lupron 5.21.18 & 8.15.18), 12.7 May 2018, 13.7 Jan. 2018, 2.1 May 2012. SpaceOar 9.6.18, testosterone <.7, 8.15.18, Tot Mayo 19 ng .17 testosterone Free 6.18.18, Gleason 3+4=7 involving 15% of the right apex and 15% of the right mid, 3+3=6 prostate cancer involving 5% of the left base. Pathology interpretations by John Hopkins, UNM Cancer, and SF Path 3+4=7 or 4+3=7 MD Anderson Proton Center w/o %. T3 MRI w/ contrast 1.8 lesion left side 5P, Neg. Bone Scan. Prolaris test 3.5 consistent with intermediate and a PTEN test negative. Father PC age 78 RT & ADT now 93 yrs. Neurogenic bladder due to lumbar disk disease and recurrent bladder neck contracture with urinary retention man. 20 years doing catheterizations. TURP & scaring 2003, Finasteride 5 milligrams daily since 2002.

JNF... you have been around long enough to know the answer already if your friend isn't happy with his current urologist find a different one and get another psa check. Why would he want to continue being frustrated with the current urologists opinions? Wish the best for your friend!!

Larry

p.s. I bet Logo is even picky with what wave he rides! LOL

JNF - that's great. You're a good friend. Getting another URO is the way to go.