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Posted 12/5/2018 12:35 AM (GMT 0)
We sometime forget that how a 92 year old decides to treat or not to treat his prostate cancer is entirely his business. Some of us dealing with metastatic prostate cancer want to see our grandchildren go to college and graduate. For that we are willing to suffer hot flushes, bone losses, and fatigues.
Posted 12/5/2018 9:39 PM (GMT 0)

Going for brachy said...
We sometime forget that how a 92 year old decides to treat or not to treat his prostate cancer is entirely his business. Some of us dealing with metastatic prostate cancer want to see our grandchildren go to college and graduate. For that we are willing to suffer hot flushes, bone losses, and fatigues.


This comment clearly illustrates what some are NOT getting with this unique case...this is NOT a one-size-fits-all scenario, as suggested. "Going for brachy" is in his 70s and recurrent PSADT is less than 2 months (low). If he doesn't treat, then he might die of PC; I would treat in his case, too. In stark contrast to "Going for brachy," the OP's friend stands very little-to-no chance of dying from PC. ADT effectiveness is measured in terms of 10-year survival rates. The best known study of ADT for nonagenarians highlighted that 10-year overall survival was only 3.1%. What did they die from? The vast majority (80%) died from OCM (other-cause mortality). Amongst the small percentage that died from PC, there was no stratification reported between those with low- and high-PSADT but think.....then apply that thought to OP's friend with the high-PSADT. The report concluded with doctors "questioning the rationale" of prescribing ADT for men in their 90's for these stated reasons, plus the more significant negative impact of side effects on QoL for the super-elderly for no apparent benefit.
Posted 12/5/2018 10:36 PM (GMT 0)
You exaggerate the impact of ADT on a very old man's quality of life. I would argue old men might very well tolerate hormone therapy far better than much younger men--especially when dealing with a diminished libido, loss of strength or weight gain, all of which come with the aging process anyway. If the 92 yr old is otherwise fit mentally and physically, and if his psa is not only rising, but rising rapidly, then ADT would potentially guarantee to slow it down and even stop the cancer growth in its tracks and perhaps preclude a lot of suffering with development of mets. Mortality alone is not the only thing he has to worry about.
Posted 12/5/2018 11:11 PM (GMT 0)

Writeblock said...
...if his psa is not only rising, but rising rapidly....


This is not the case with OP's friend. Don't treat all cases the same with the old-school "one-size-fits-all" mentality of the 1990's.


Writeblock said...
I would argue old men might very well tolerate hormone therapy far better than much younger men.


Well...you are entitled to your opinion. That opinion is the polar opposite of the expert physicians who have studied and reported on this in PubMed. Possibly you missed this passage in my last post: The report concluded with doctors "questioning the rationale" of prescribing ADT for men in their 90's for these stated reasons, plus the more significant negative impact of side effects on QoL for the super-elderly for no apparent benefit. After analysis, I have aligned my personal opinion with the experts. You are absolutely entitled to voice whatever opinion you see fit; but don't be "indignant" when someone shoots holes in it.

Post Edited (Blackjack) : 12/5/2018 4:16:18 PM (GMT-7)

Posted 12/6/2018 12:04 AM (GMT 0)
Not only am I not arguing one size fits all, I'm doing just the opposite. I only addressed the issue of the OP's friend who, we're told, is a fit 92 with a psa count of 12. But we don't really know his psa trend line, something the OP was at pains to point out and which you pass over. You simply can't know his situation. He could develop mets soon--or not. We just don't know. Those who discourage tx based on age using mortality studies miss the point imo. Stopping the cancer from expanding may well have enormous psychological as well as physical value. It's not just mortality his urologist may want to preclude.

As for my discussing adt in terms of age differences between old men and much younger men, it's not just my opinion, it's my experience. It's also common sense. Loss of libido, diminishing testosterone, weight gain, generalized weakness are all symptoms we associate with the aging process. It's only natural this would upset younger men more than someone in his early 90s who has already dealt with such trials.
Posted 12/6/2018 12:22 AM (GMT 0)
Writeblock has made some great points in his posts. It is a given that Blackjack will go to great lengths to “prove” his point, as usual. One thing we don’t know is the man’s true PSA velocity. After informing me that I’m confused, Blackjack made some assumptions that may, or may not, be true based on minimal information. Because PSA velocity is not necessarily static, his doubling time could be quite rapid right now.
Posted 12/6/2018 12:28 AM (GMT 0)
(Rule 3 violation removed)

Post Edited By Moderator (Tudpock18) : 12/6/2018 10:56:03 AM (GMT-7)

Posted 12/6/2018 1:11 AM (GMT 0)
Write block,
ADT weakens bones, has negative cardiac effects, affects mental functions, weakens muscles, causes fatiege, causes breast enlargement. These are not trivial for a 92 year old. Unless mets is already to the bone he is unlikely to experience any negative symptoms from PC in his lifetime.
Posted 12/6/2018 1:30 AM (GMT 0)
Some things to know about psa doubling time. ALL cancers have to double 44 times from inception to death. Diagnosis is usually made at about 30 doublings. Psa post treatment is an accurate way to measure tumor growth rate. Tumor growth rate is determined by the DNA in the original cancer cell and does not change.
Posted 12/6/2018 2:19 AM (GMT 0)
ADT may have these negative side effects, true. But weakening of bones, cardiac issues, fatigue are risks for everybody equally--age is beside the point. Not everybody responds to ht in the same way, although a 92 yr. old man wants to avoid mets as much as a 52 yr. old guy. The issue is for him and his urologist to decide based on the danger confronted, not age per se. If he's lucky he'll do just fine--just like many many others.
Posted 12/6/2018 1:39 PM (GMT 0)
I have an 84-year-old client. She has been widowed for 10 years. She plays golf. She takes her grandchildren on ski trips, and yes, she skis herself. In both Vermont and Jackson Hole. She has a personal trainer come to the house three times a week. She still works in the family business. She’s a little nuts but sharp as a tack

This is a very personal decisions that should only be made by the individual in question. Even if the treatment is not going to prolong his life much, if it gives is mindset a big lift, to fight, and to stay healthy versus feeling dejected buy doing nothing That might be enough of a reason to test or treat or both
Posted 12/6/2018 5:14 PM (GMT 0)
We all want to make our own health decision when we are older, but we act is if it is zero cost and that there are no downsides. Our health care costs are 17% of GDP, higher than any other industrial country which are in the 7% to 10% range with identical outcomes. Over 70% of our total costs are expended in the last two years of life. Therefore late life health decisions are very costly to our society. We simply cannot provide the end of life health care everyone wants and provide good health care for all at the same time.
Medicare is not insurance we paid into. We pay in approximately $35,000 and get $350,000 in life time benefits, someone is paying the difference (our Grandkids), and it is supposed to be insolvent by 2035. We as a society have to make some hard decisions. Do we give a hip replacement for someone who has terminal lung cancer? My friend had one 2 months before his death. Do we give ADT and expensive scans to a 92 year old that in all probability will not extend his life one day and will most probably shorten it? How much is an extra 2 months of life worth? These are hard questions that someone is going to have to address given the push for health care for all.
Posted 12/6/2018 7:29 PM (GMT 0)

Writeblock said...
But weakening of bones, cardiac issues, fatigue are risks for everybody equally--age is beside the point.

It appears that you just stated that…
i) weakening of bones,
ii) cardiac issues and
iii) fatigue
…are NOT age related and/or increasingly important as people move into old age ("age is beside the point")…or in this particular case for the super-elderly? Did I read that right? Can you support that?

I would just politely point out, again, that your statements are the polar opposite of the medical community’s understanding of human life and the human body. The evidence presented below for your review are important to the elderly, but they are each multiplied in importance with the super-elderly.

Review of the most easily obtainable evidence, in the order you presented, which is contrary and polar opposite of your statement:
i) Link: MedlinePlus article (NIH US National Library of Medicine) titled “Aging changes in the bones – muscles – joints”:
    “People lose bone mass or density as they age.” “Effect of changes: Bones become more brittle and may break more easily.”

ii) Link: PubMed article titled “Cardiac aging and heart disease in humans:
    ”Aging represents the largest risk factor for cardiovascular disease.” “With age being the dominant risk factor for the development of cardiovascular diseases, their prevalence increases dramatically with increasing age.”

iii) Link: WebMD article titled “What’s Normal Aging?”:
    ”As you get older, your blood vessels and arteries become stiffer. Your heart has to work harder to pump blood.” “The resultant fatigue in the elderly can lead to a decline in normal functioning.”


Age is exactly the point

Just opinion one man's opinion…[understatement-of-the-day]
Maybe you want to "re-think" that earlier post.
Posted 12/6/2018 7:38 PM (GMT 0)
As the OP who hasn't visited in a few days, I see this has degenerated into the usual piss*ng contest among aging boomers with too much time on their hands.

If any of you "get off of my lawn" crowd gives a crap, he got the shot yesterday. So I think we're done with this thread.
Posted 12/6/2018 7:50 PM (GMT 0)
You ask, "Do we give ADT and expensive scans to a 92 year old that in all probability will not extend his life one day and will most probably shorten it?" My response is that you exaggerate the results of such tx. Scans could very well extend life if mets are discovered early. And adt has the potential to stop the cancer from progressing, perhaps extending life, not shortening it. Undergoing a few scans would not shorten a fit 92 year old's life.

The issue basically is an ethical one. Individuals differ greatly, Some very old people are very healthy. How do we in good conscience ration care for an otherwise fit 92 year old man who might very well live another ten years when we do not do so for younger individuals with chronic co-morbidities such as diabetes and heart disease? Using age alone to make such determinations is a crude yardstick.



.
Posted 12/6/2018 7:50 PM (GMT 0)
Thanks for the update tutor_paul...sorry we couldn't help.
Posted 12/6/2018 8:06 PM (GMT 0)
Blackjack, you misrepresent what I said. I said these are risks that everybody faces who undergo ht--but not all risks eventuate for everybody. Some have only minor problems and handle adt very well. The elderly may even have an advantage insofar as they can better tolerate libido and testosterone diminishment and loss of strength generally, dealing with such issues as a matter of course. As for your citing experts, a few statements out of context don't make a cogent argument. Sure old people are more prone as a group to have more cardiac issues. But not all old people--which was my point. One size doesn't fit all.
Posted 12/6/2018 10:38 PM (GMT 0)
Thanks for the update tutor_paul...glad we could help.
Posted 12/6/2018 10:42 PM (GMT 0)
The OP asked us for our opinion and several responded and now he calls us "aging baby boomers with too much time on our hands." Too bad. I thought the thread was interesting and informative, with generally thoughtful, respectful, well-written responses.

Apparently the OP disagrees. I wont disappoint him again with my response. I had one ignore, now I have two.
Posted 12/6/2018 10:57 PM (GMT 0)
Well, in a sense I understand the OPs anger. The overtones from some posters seemed discard the man in question to the dust bin. Too old to waste any money on him and too feeble to make his own decisions. I think some posters were most interested in proving they were right. I don’t know if I fell into that category.

Paul, I hope your friend does well.

PS Paul you also qualify as a Baby Boomer, if you didn’t already know it. 😉
Posted 12/6/2018 11:04 PM (GMT 0)
wow, even after the OP says, "done" people keep posting. Amazing disrespect shown in this thread.

Mods - it should be locked.
Posted 12/6/2018 11:33 PM (GMT 0)

hrpufnstuf said...
I thought the thread was interesting and informative, with generally thoughtful, respectful, well-written responses.


Agreed, hrpufnstuf. The discussion this topic generated (at least the civil part) transcends any one person/poster...

Aging is a universal topic.
Posted 12/7/2018 12:57 AM (GMT 0)
I think this thread has both run it’s course and served its purpose, and then some. So I’m locking it.
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