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Age 70 -- and it's decision time

Bushmills
Posts: 6
Joined: Jul 2009

Wow, could I use some advice and words of wisdom.

I'm 70, diagnosed two weeks ago with prostate cancer. The basic stats are PSA 7.8, Gleason 3+4=7, stage T2a, with (ouch!) perineural invasion. So it looks like the cancer probably has gotten outside the prostate. I'm in good health and very active. Probably good for another 10 or 15 years if not for the cancer.

My doc recommends radiation -- maybe because I'm a bit old to have to endure recovery from surgery, or maybe because a prostatectomy most likely won't get the entire cancer. So I'm interviewing a couple of urology surgeons and a couple of radiation oncologists to get their take on the thing.

But you know, I don't think I'm especially worried about dying or about being incontinent or impotent. I think what I'm really afraid of is living a life full of ongoing small and big pain, discomfort, not sleeping because of getting up to pee all the time, of being in pain when I have a bowel movement, of all the little and big insults that can come from treatment. That's where this forum is helping me the most, because I'm seeing how a good and active life can suddenly be so compromised. And I want to know what this is like, how it feels, so I can be ready to deal with it and accept it and yet continue a satisfying life that doesn't dwell on my disease.

I'd especially like to hear from someone my age, to hear how they're doing and what prostate cancer has meant in their life. Thank you so much.

lewvino's picture
lewvino
Posts: 1004
Joined: May 2009

Bushmill,
What part of the country do you live in? I'm younger then you (54) and waiting for DaVinci Surgery on August 12th. I joined a local PC support group. There is a man in the group (Haven't actually met him yet) who just went through the DaVinci surgery about 3 weeks ago at Age 72. He saw the Same Dr. that I am Dr. Smith at Vanderbilt, Nashville, Tn. I heard yesterday that he has had the catheter removed, is walking and was back in Church. I do not know any of his numbers, etc.

Mine our 5 of 12 samples came back as all Gleason 7's mixed (4+3 and 3+4) with signs of the perineural invasion.

My father was treated with Proton Radiation Treatments when he was 65 and is doing fine today 12 years later. All though he is no longer able to get an erection.

Larry

Bushmills
Posts: 6
Joined: Jul 2009

Lewvino,

Hi. I'm in Seattle. I'd love to hear from the 72-year-old guy who just had the robotic surgery. I'll bet he could help with some good pointers. Any chance he'd respond on this board? Or I could provide my private email and he could write to there if he preferred.

lewvino's picture
lewvino
Posts: 1004
Joined: May 2009

There is a chance that he will be at our next local Prostate Cancer support group. If you want please forward me your email address to lewvino@yahoo.com I can then take your email address to the meeting Monday night July 13. If he is not there I will be more then happy to give it to the president of the club who goes to Church with the Gentleman. You might want to give a short introduction in the email about your situation and I will give it to him or the president of the local chapter.

Keep up the faith.

Larry

lshick's picture
lshick
Posts: 63
Joined: Apr 2009

Welcome to the Club.

I would only suggest that you check your assumption/assessment that perineural invasion is necessarily so bad. I've read that it's often (usually?) of no consequence. So you may want to find someone who knows what they're talking about on that score.

With a T2a you have plenty of options.

2ndBase's picture
2ndBase
Posts: 220
Joined: Mar 2004

My cancer was already spread and at age 52 I had the Lupron shot followed by 40 radiation treatments. You should at least get the radiation which should be enough to insure that you will not die of this cancer. Surgery is not a good choice if it has spread and the side effects will be more severe than with the radiation. Your numbers are much lower than mine were and I was going to die within a year or so had I taken no treatment. You will be fine and the side effects are not that bad from radiation. The Lupron is a bit more severe in its side effects as you probably know. I have survived 5.5 years and though my cancer is back and trying to end my life I found that getting all the stress out of my life has been a great medicine and whether or not I decide to persue more treatment I will not let it worry me. Stay strong and enjoy what you have.

shubbysr's picture
shubbysr
Posts: 87
Joined: Jun 2009

Hey Bushmills,

Welcome to the club. It seems that you have the same questions,concerns, etc. as the rest of us (just a little older, perhaps)
You have to trust your doctor and trust in God, that the right decisions are made and you can handle the consequences of those decisions.
Again, good thoughts and prayers going your way.

Jim (shubbysr)

Bushmills
Posts: 6
Joined: Jul 2009

Dear Larry, Ishick, 2ndBase and Jim,

Bless you for your information and for your words of advice and encouragement.

Don

lshick's picture
lshick
Posts: 63
Joined: Apr 2009

If you're still watching this thread:

I've gone over the websites and notes that I have. Perineural Invasion does not figure in any of the nomograms/predictors of survival I have seen. I had PNI (in post-surgery pathology), and the surgeon waved it away. One paper I read said that nearly every prostate on post-surgery pathology has PNI.

It seems (from reading the journal articles) that PNI is not a good thing, but it's not independent. That is: if A causes (with some probability) B, then if A gets worse, you'd expect (with some probability) B to get worse. But if A is really the Really Bad Thing, then B is in a sense sort of an innocent bystander, convicted by circumstantial evidence so to speak.

I'm no medico, so bring a skeptic's attitude to what I'm saying, but I would suggest a skeptic's attitude about the importance of your PNI.

lewvino's picture
lewvino
Posts: 1004
Joined: May 2009

My Local Doctor explained my PNI to me this way - There are many tiny nerves that are inside of the prostate and that is what they see during the biopsy if those nerves are seeing signs of the cancer attacking them. If the cancer succeeds then it can spread to the larger nerve bundles outside of the prostate and to the rest of your nervous system. He advised not waiting to long before having treatment. He said up to a year should be fine. I was diagnosed around Early April and Having my robotic surgery in August.

lshick's picture
lshick
Posts: 63
Joined: Apr 2009

Another path you should explore is doing nothing.

At 70, barring other health problems or Really Good Genes, you have (statistically) about 13 years left. Give or take.

According to Scardino's book (p.110) an untreated prostate cancer will take (statistically) 15-17 years to kill. Give or take.

Depending on your (currently unknowable) response to the (currently unknowable) side effects of a more aggressive treatment modality, doing nothing just might give you 13 good years instead of 13 miserable years.

Again, I'm no medico--talk this over with advisers you trust.

Bushmills
Posts: 6
Joined: Jul 2009

Notes for Lewvino, Ishick, and 2ndbase.

Lewvino: Thanks for your doc's take on perineural invasion (PNI).

Ishick: Significance of perineural invasion is quite a controversy, I'm learning, even among the various docs in my Group Health HMO. So-called "watchful waiting" isn't really an option for me given my 7 Gleason and my staging (T2a; a cancer that can be felt on the prostate).

2ndBase: The latest recommendation I'm getting is just what you're undergoing: Lupron first, followed by 40 doses of radiation. I'm not liking it, but . . . . . could you give me some info about your experiences in dealing with Lupron and its effects? Some hard gory detail would be really useful. (And how is to get the shots? Anything special?)

Don

jnetc
Posts: 19
Joined: Jul 2009

My husband was T2c NO MO.. clinical path before surgery with 85% of prostate ate up with cancer Gleason of 9. He desided that he wanted the prostate OUT no matter what.. SO he went with surgery and now having lupron because they found it in his lymphnodes in pelvis and having radiation in the fall....

SO far NOTHING really bad is happening with Lupron

barbercheech's picture
barbercheech
Posts: 2
Joined: Feb 2011

Hi , This is my First Reply to a question But i Will do My Best To Answer About lupron Shots. I Also Have Had A Gleason level of 7 . I have had 44 Radiation Treatments of The best Available Witch Includes Sonagram Directional Guiding for each treatment . I Have Had 25 Pounds Wieght gain Because Of The Lupron Shots And hot flashes Every Couple Hours For Two Years and Have Lost My Sex Life for Now Even Though Because I Am 62 The doctors say It will come back after The Shots Are Done . My PSA Is Now .005 From 46 yes 46 . Hot Flashes Are Not Fun But You need To Realize wemon Have Gone Through Them Since The History Books Have Been Written. The big Thing i found Was to Wear Layers Of Clothes You Can Put On And Take off Depending On how Often They Last. I Am taking A Pill Once A Day Called Megestrol AC 20mg That Seems to help. Keep the faith and god Bless

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