Prostate cancer age related

jerryw478
jerryw478 Member Posts: 5 Member
in Prostate Cancer #1

so I’m 77 years old and was just recently diagnosed with prostate cancer with a score of eight and PSA of 6.6. I had a bone scan and a PET scan and it showed that the cancer has not spread outside of the prostate so that’s the good news. Surgery has been recommended but everything I read and seem to witness on these chats is no one has been my age and that there are more complications once I’m over 75. I am in very good shape and eat very years and have a very active lifestyle without tobacco or alcohol for many years. My seems to think I will come through this just fine however since I’m 77 I’m also realistic and know that there are not that many years left and I don’t really want to spend them doing a physical therapy or being down from my active lifestyle. I would appreciate any feedback or any experiences from people that might be able to share on this particular subject. All inquiries will definitely be taken into consideration as I definitely try to keep an open mind surgery for January 16

Comments

  • Wheel
    Wheel Member Posts: 162 Member
    #2

    I am surprised your Surgeon is recommending Surgery as around 75 appears to be a cut off. That must speak to your good health. Overall I can see if someone is in good health the surgery recovery is not much longer than a gallbladder. Obviously the gallbladder does not give you the incontinence or ED issues, but even the incontinence is greatly diminished or gone with some of the newer surgical procedures with the robotic laparoscopic prostatectomy. If it continues it seems for most to clear within a year. All surgeries carry risks even a hernia or getting your tonsils or appendix out. At your age ED I imagine would be less of a concern and at that age most men are having a level of ED anyway. I would want the quality of life that a quick surgery could return to you versus undergoing Radiation along with the likelihood of Hormone treatment. That Hormone treatment seems to impact a quality of life much harder. I think you are fortunate to be in such good shape your Doctor is recommending the surgery. That you will likely not get a second offer as you age more.

  • jerryw478
    jerryw478 Member Posts: 5 Member
    #3
    https://csn.cancer.org/discussion/comment/1719190#Comment_1719190

    thank you very much for the prompt feedback, yes, I am in pretty good shape and I don’t take any medication other than a 25 mg blood pressure pill and I’m very active also. very good point about me not being able to have that choice as I get a little older, and everything I read about the radiation procedures do not inspire confidence in me. you’re right about not worrying so much about the ED issue and I can probably work around the incontinence issue as well, my biggest concern is being able to get around since I am pretty independent.

  • Clevelandguy
    Clevelandguy Member Posts: 1,206 Member
    #4

    Hi,

    I would talk to your surgeon and if he says age should not be an issue than go with it. You could physically be in better shape than someone in their mid sixties if your health screening is impeccable. If you choose radiation, Proton therapy does not require anesthesia to insert protective gels to keep your Rectum safe. If your going with external beam radiation using xray type beam you could be put under general anesthesia to insert the gel, and if that’s the case then take the anesthesia hit with the surgery. A second opinion from a different hospital network if available might be a good idea.

    Dave 3+4

  • jerryw478
    jerryw478 Member Posts: 5 Member
    #5
    https://csn.cancer.org/discussion/comment/1719199#Comment_1719199

    thank you for the feedback. I appreciate your prompt reply., It does look like I’m going to go with the surgery

  • NYguy99
    NYguy99 Member Posts: 10 Member
    #6

    Hi Jerry. Yes, always a tough decision (I posted my decision making process under - RU just diagnosed and overwhelmed? My humble non-medical advice - depending on your location, please try to get a second and third opinion. I ended up at Sloan Kettering and am happy that I did. The Gleason 8 means it will be treated as more aggressive. You didn't say how many total biopsy samples were cancer and how many were 4+4. That info might determine if they want to add ADT if you had radiation. You might want to have a cancer center re-read the slides and MRI to verify your info. You also did not mention if you had the decipher report run. If that shows a low probability of reoccurrence and spreading, you might want to rethink radiation. I chose the 5 radiation treatments, just to minimize the side effects ( worried about incontinence) and only a few daily radiation pre-treatment prep. If you do stick with surgery, PLEASE ask him how many surgeries he has performed. Ask if they have verify a negative margin while you are under and still on the table. My biggest fear was having the surgery, only to find out in 6 months they didn't get it all and I would need radiation anyway. However, if I was Gleason score 8 (mine one sample was 4+3), I probably would have went with surgery if they thought they could achieve a negative margin. Sorry to add to the confusion if you have settled on the surgery. Best of luck.

  • mamakath
    mamakath Member Posts: 4 Member
    #7
    https://csn.cancer.org/discussion/328720/prostate-cancer-age-related

    Hi Jerry. My husband is also 77 and was just diagnosed in April with a Gleason 4 + 4 and a PSA of 19.6. His Urologist sent us to both a surgeon and a radiation oncologist to listen to them both before making a decision as to treatment. Let me say that just because anyone is 77 DOESNT mean that sex is NOT important! We have been married over 50 years and it’s STILL important! When my husband told the surgeon- a VERY young doctor- that very thing, he closed his book and said, “You should have radiation “. Gave us a good chuckle in a very serious situation. In August, my husband had a Halop procedure to reduce the size of his “ginormous” (according to the urologist) prostate. He is to heal until after the holidays and then the amount/length of radiation will be determined. His incontinence lasted about 2 months, but never enough to keep him from living his usual life. The only drawback so far is the ADT. That has been hard. We hope by Spring it will be Spring for us too! Hope our experience helps. This is really the pits for everyone.

  • jerryw478
    jerryw478 Member Posts: 5 Member
    #8
    https://csn.cancer.org/discussion/comment/1719241#Comment_1719241
    https://csn.cancer.org/discussion/comment/1719266#Comment_1719266

    thanks for reaching out. I appreciate it, I tested 11 out of 14 on the samples and they were 4+4, they also did a Polaris test and that was as well. The good news is it was contained capsule. my doctor told me he has done over 1500 of these surgeries obviously not all robotic since that’s new I guess.

    https://csn.cancer.org/discussion/comment/1719266#Comment_1719266

    thank you for reaching out, I’ll be seeing the dock in about a and I will bring that procedure mentioned up, glad to hear that his incontinence stopped so soon that’s one of my concerns, my that big according to the urologist

  • Marlon
    Marlon Member Posts: 127 Member
    #9

    When I (67) was given the choice, my doctor said I was on the borderline age-wise. If I was younger, they would recommend surgery - older, they would recommend radiation. What he said was that either way, I would likely have a good outcome. I asked him what was good, and he said either way, I would survive at least 12 more years. So your expected lifespan is an important consideration.

    I chose surgery, because I wanted the cancer out ASAP. And as a byproduct, my BPH is gone. It turns out that the post-surgery pathology showed the cancer was a bit more aggressive than they thought. So he and I were both glad that I chose surgery. The lesson being that they dont really know what's going on until they get in there and see. Radiation might have worked too, but its a best guess treatment.

  • jerryw478
    jerryw478 Member Posts: 5 Member
    #10

    thank you for that and I totally agree about you don’t know until you get in there. Through all the posts and all of the discussions I’ve seen on the various chat etc. it seems to me that the surgery seems less complex. I am blessed with the fact that I’m in pretty good shape and nounderlying health conditions. either way on looks like it’s not a lot of fun. I’m just hoping that it doesn’t last too long getting back to normal.

  • HerndonBoy
    HerndonBoy Member Posts: 7 Member
    #11

    I am 75 and faced a choice between surgery and radiation + ADT. Spoke with two urologists who said I was up to surgery. I also consulted an oncologist and radiation oncologist. My PSA was 10.1 and the Gleason was 4+3. Neither the MRI nor PET showed any spread beyond the prostate. After wrestling with this I chose surgery. It was back in August so I am about 4 months out now. My stay in hospital was two nights. The catheter presence and removal were fine. However, I am still incontinent, but have learned to deal with it as an inconvenience. Plus I am in PT. It should get better. Sadly I am a widower so the ED is what it is. We all are different with varying experiences. Best wishes.

  • Marlon
    Marlon Member Posts: 127 Member
    #12
    https://csn.cancer.org/discussion/comment/1719283#Comment_1719283

    HerndonBoy, I am now 5 months out, and while I am dry most of the time, an occasional drop or two still gets out. I think I will be using a pad or shield just for the security, for an extended period of time. I had PT as well, and it helped a lot. The therapist said I pretty much need to keep doing exercises indefinitely to prevent the normal loss in muscle tone as you age. I think I just had the first entire day where I had no unusual sensations and felt totally normal.

  • Old Salt
    Old Salt Member Posts: 1,530 Member
    edited December 7 #13

    jerryw478:

    In your first post you wrote that surgery was recommended. I wonder by whom. Urologists tend to favor surgery; that's their craft. Just looking at your numbers, you SEEM to be a perfect candidate for radiation, but I don't know all the specifics.

    Just for reference, I was 70 when prostate cancer was discovered (multiple Gleason 9 lesions). My urologist told me I was too old for surgery (bless his heart). Instead, he recommended two kinds of radiation + 'hormone therapy' and that's what I did. I believe that was pretty much SOC at the time. I recovered pretty well and (still) lead an active lifestyle, about ten years later. 😀

    I highly recommend that you look into Stereotactic Body Radiation Therapy (SBRT). Often this is done with a Cyberknife instrument (there are others) in five sessions for a patient such as you. SBRT is yet another specialty in the radiation oncology domain and there may, or may not, be a facility in your neighborhood.

    As is often mentioned, whatever therapy you choose, you want a doctor and institution with lots of experience.

  • centralPA
    centralPA Member Posts: 341 Member
    #14
    https://csn.cancer.org/discussion/comment/1719266#Comment_1719266

    @mamakath , I'm hijacking the @jerryw478 thread to ask you a question about what I assume is a 'HoLEP" procedure your husband had. That's what I had too. Ginormous prostate. The removed tissue should have been looked at by a pathologist. What did they find?

  • mamakath
    mamakath Member Posts: 4 Member
    #15
    https://csn.cancer.org/discussion/comment/1719361#Comment_1719361

    Hi Central PA, here’s his results.

    149 grams of tissue removed

    Prostatic acinar adenocacinoma Grade 1 (Gleason 3+3) Don’t know why he had scored 4+4 previously

    Tumor involves less than 5% of tissue

    Glandular and stromal hyperplasia

    Invasive carcinoma involves approx 2-3% of examined tissue.

    Hope this helps. Long road ahead…

  • centralPA
    centralPA Member Posts: 341 Member
    #16
    https://csn.cancer.org/discussion/comment/1719364#Comment_1719364

    Thanks!

    With that huge of a prostate, any biopsy would be a sparse sampling of the prostate. Also, most cancers are found in the Peripheral Zone of the prostate, while a HoLEP removes the transition and central zones (the inside). It is good news that the middle wasn't completely swamped with cancer.

    Best of luck!

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