It should be overall health that rules RP in/out as a treatment option, not age

Treating age 70 as some kind of limit on the advisability of having an RP is an outdated concept.

Trends in surgical treatment for prostate cancer: Analysis of National Database open Data in Japan (2023)

"Abstract
We conducted a study to clarify the trends in surgical treatments for prostate cancer in Japan between 2014 and 2020 by analyzing the National Database (NDB) open Data in Japan. Intriguingly, the number of patients over 70 years old who underwent robotic-assisted radical prostatectomy (RARP) nearly doubled from 2015 to 2019, while that in those 69 years old and younger remained almost constant during the same period. The increase in the number of patients over 70 years of age may reflect the fact that RARP can be safely applied to elderly patients. With the new development and spread of surgery-assisting robots, we can foresee a further increase in the number of RARPs performed for elderly patients in the future."

Application of robot-assisted radical prostatectomy in men over 75 years: an analysis of comparative outcomes (2023)

"Conclusion: Our study revealed that the perioperative, oncological, and functional outcomes in men aged over 75 years undergoing RARP were not significantly different from those of their younger counterparts. RARP is feasible in men aged over 75 years."

Can men 75 and older safely receive a minimally invasive radical prostatectomy? (2023)

"Complications and 30-day outcomes remain within an acceptable range to offer surgery in men 75 and older. Age alone should not disqualify men from receiving a RP, but appropriate patient selection and counseling are necessary."

At my last visit I asked my uro/surgeon if he has a hard-and-fast age limit on performing a RP. He does not. Clearly, cardiac and overall health are of fundamental importance, but that holds true for men under 70 as well. I had my successful RP at age 69. I'll be 75 next month. My overall health, including my cardiogram, is basically unchanged since then, and I would hope that I would be offered a RP had I needed treatment now rather than at age 69.

Djin

I am glad that I had surgery in that it removed the majority of the cancer including the more advanced cancer cells within the mass. IMHO, the longer the primary tumor is left undisturbed, the more advanced individual cancer cells within it become.

Removing it and chucking it in the trash gives the patient a felling of control. I also do not think age should be the primary factor, rather, the patients overall health should drive the decisions.

I had a lot of aggressive PCa and it was immediately deterred by Eligard, Casodex, Avodart, HDR brachytherapy and IMRT. It had no more time to advance and grow than if some of it was removed by surgery. It was clear in my case that surgery would not cure as the PCa was already outside the capsule and likely in the lymph nodes. Then, I was hopeful that the advice three surgeons gave me that they would not operate was correct. Today, I am absolutely convinced that surgery would have been harmful and would allow more time for cancer that could not be kicked to the trash can to advance and cause more damage. That I remain PSA undetectable and with no negative treatment side effects is clear evidence of the tremendous effectiveness of modern radiotherapy that only a fool would say I would have been better off to have used surgery.

Like F8, I recognize that with PCa there is really no need for surgery or even a good reason to subject a man to the inherent damage any surgery does when we have such effective radiotherapy methods available. That is my clear and admitted bias based on now more than 12 years of studying the situation. I have had three other surgeries since PCa for situations where surgery is really the only effective treatment available, so I am not against surgery in and of itself, just when there are equal or better treatment options.

Jack64 said...
JMO, Once again regarding surgery or radiation regardless of age. I think it all comes down to how aggressive the cancer is. If the cancer is considered contained and the GL score is lower then surgery can be the way to go. However, if the GL score is high then more than likely there will be salvage RA, ADT and possibly Chemo down the road at some point. Why go through surgery with the chance of adding incontinence and other SEs. I have read many posts here where surgery was the first choice which was then followed by savage RA and ADT. If surgery and RA are both used to kill the cancer why start with surgery if the DX is considered aggressive PC? Many of us were told by UROs in the past that surgery was not an option after the age of 70. I just wonder how much input UROs had in this study. I know the gut reaction is to want to get the cancer out. I have also heard that having surgery to remove the prostate after RA is probably a no go. RA to other areas can still happen. Again, JMO, but it sure seems that there are not that many one and done outcomes noted here with surgery regardless of age. Of course the majority here have had the more aggressive forms of PC. Regardless, it will always be a personal choice and once made no looking back. Djin, thanks for the article and congrats on your outcome, you I believe are a true outlier given your DX.
My best to all,
Jack

"If the cancer is considered contained and the GL score is lower then surgery can be the way to go."

and why is that?

are you saying radiation cannot eliminate contained cancer?

F8 said...
the threads on surgery side effects and the subsequent procedures that usually at best provide a partial solution read like horror stories to me. if the urologist were not a surgeon i believe we'd see far fewer surgeries for prostate cancer as well as far fewer life altering SEs

Probably true but my point is that forums do not represent the typical PCa survivor thus conclusions drawn from reading them are suspect nor is what happened to the guy down the street 20 years ago particularly meaningful. I didn’t want any of the radiation side effects either and glad I didn’t have them.

Haven’t been here as much.

Good to see some things never change.

😊

halbert, thank yo for that. I am very close to abandoning this forum due to the “advocates” who tout a position on what is supposed to be a support venue with their thinly veiled personal attacks on choices others have made.

You are certainly correct that many decisions are made for non-medical reasons. Here in Montana we only have 5 cities of size, with lots of space between them, and even in the largest, options can be limited. Driving to, say, Billings, for treatment when one lives in Sidney, Plentywood, or Ekalaka is just not going to happen, especially when there is a farm or ranch to be operated.

Add to this, the latest medical facility in the state is on hard times and is currently reducing doctors’ salaries and stopping contributions to employees retirement plans. They’d have a high turnover in staff and getting to see a specialist is chancy.

I researched all of the options available to me and felt I made the correct decision for my situation. I chose surgery at age 61. I never had a day of incontinence after the catheter was removed, had intercourse (with a semi) in the first month after surgery and had no ED after about 5 months. Surgery was the correct choice for me. When I speak to others about their choice I only relate my experience including what I believe is true-my surgeon is a master and choosing surgery must include choosing a highly experienced surgeon. I would never consider guiding anyone to surgery or away from it. The choice of treatment type is a completely personal decision.

What frustrates me is the number of men who choose a treatment without doing any research, relying only on the advice of the urologist who performed the biopsy. This is the biggest problem in the PC industry. Ignorant patients rarely get the outcome they think they will have.

Central: I was treated at Barnes-Jewish hospital in St. Louis.

To my fellow posters. It would seem I have the great ability to join in on a thread with my opinion that causes great debate. The debate about vaccines, mask wearing and the “SLAP” threads come to mind. Now, my opinion on surgery after 70 and surgery in general has caused some veterans to grow tired or say they might leave the forum. I don’t agree that debate on RA vs Surgery is a bad topic. Both surgery and RA seem to be advancing their fields very rapidly. With these changes come new perspectives on which to choose. It is always my opinion that it is a personal choice in deciding on any treatment. I also feel that a newbie coming on should not only be given encouragement and answers to questions, but also see outcomes of any treatment in a broader picture. I have been here for a year and a half and still have to look down in many profiles to see what each member has gone through. I look for what treatment they chose, the SEs they had and other treatments that were required. The debate about surgery vs RA sure seems to bring that information to the forefront. In any case, I can understand the frustration of the veterans that have been here a long time and have heard it a hundred times before. Funny thing is, I hated debate in college, but now I see it as a way to gain more knowledge on any subject. I guess that is the teacher in me, always wanting to learn new ideas.

I have several things I want to state about this forum and about my beliefs. First, this forum is with out a doubt a valuable resource on all topics PC to newbies and veterans alike. The vast knowledge gained here is not something you can just read about in a book or hear in great detail from any doctor. The camaraderie of the bothers and sisters here is beyond compare. The compassion given and the willingness to answer every question is without a doubt this forum’s greatest strength.

For me this forum has been my go to when feelings of doubt creep up. It has been my place to vent, give my updates, my opinion, learn and to laugh at the Friday humor. To hear veteran’s updates after years of being treated for PC is a reassuring feeling much needed. It is also a place of sadness when some succumb to the disease.

I now feel it is time to step aside since my ADT has stopped and let the veterans help others with their vast considerable knowledge. I will return once a month to see how everyone is doing and provide updates on how my recovery from 18 months of Orgovyx is going. Don’t think this me backing away from debate. I just don’t want to see any valuable veterans leaving here due to frustration. Sorry this is so long, but just going away without thanking all that helped me or explaining why is not in my DNA.
To all my brothers and sisters, thank you all.
My best wishes and don’t give up the fight.
Jack

I will always believe in the exchange of different ideas and opinions, even ones I don't agree with. The right to do so is the foundation of this country. I hate that our country has become obsessed with censorship of others speech, opinions and even choice of what words one can speak. I don't believe it does anybody any good for this site to be about debating different treatment options. I always thought Healing Well was should be about information and support. Rather than offer constructive input, one frequent poster constantly opines his choice of radiation is the only correct choice. In one post he referenced surgical patients as "being mangled by their surgeons." This serves no purpose other than to make him feel better about himself. It's poor manners and a lack of class. I've been on this site for + 2 1/2 years. I'm out of here. I found another chat room that is most welcoming, minus the toxic environment with a fantastic moderator. I won't mention its name as I don't want the "bad apple" over there. Thanks to the rest of you for years of encouragement, especially Djin for his incredible knowledge and Cyclone for unbelievable kindness and encouragement.

There are studies suggesting anesthesia is associated with cognitive decline in older patients and the exact mechanism causing this is not well understood yet. Personally I am hoping all the major surgeries are behind me as I approach 70.

Heck, I’ve linked in my Twitter thread to doctors publicly slagging on each other for over-promising on RALPs, poorly done RT studies, and other random grievances. In public.

I’ve been on the internet a long time. This place at its worst is a pillow fight.