Anyone have a radical prostatectomy at 78 years old or older? If so, how was your experience?

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My father who turned 78 this year was diagnosed with prostate cancer about a month ago. His cancer was found following TURP surgery from an enlarged prostate. He has a Gleason score of 7 (4+3, not 3+4) and we're heading into the doctor's office tomorrow to get his PSA test results and to discuss what we're going to do about the cancer moving forward.

My father is very seriously considering a radical prostatectomy. He just wants the cancer removed, asap. When the doctor informed us of my dad's diagnosis a month ago, my father asked, "why not just remove the cancer, or the entire prostate?". Immediately, the doctor responded by saying, "No, you don't want that. No. You could experience extreme incontinence". That said, the doctor didn't even bat an eye when he responded to my father about having his prostate removed.

Due to my father's age, I believe the doctor is concerned about side effects that someone of my father's age could experience following this type of surgery. If my father was younger, I think the surgery would have been scheduled almost immediately following his diagnosis.

Having said this, years ago, a good friend of my father's had a radical prostatectomy at 80 years old and did not experience any extreme side effects or health repercussions.

Has anyone here 78 and over had a radical prostatectomy? If so, I would appreciate hearing about your experiences, both good and bad.

Thank you in advance! 😃

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  • Posted

    i am 77 and have a similar Gleason to your father . However I opted for AS when the cancer was detected and since then have had 3 biopsies and many MRI Crucially my cancer is not threatening the capsule so feel comfortable with AS . The older you are the more likely the cancer will be a pussy cat and hence i understand why your father's urologist is recommending AS . He could consider radiotherapy of course .

    cheers Keith

    • Posted

      Thank you for your response, Keith.

      Can I ask...how long you were diagnosed?

      And in terms of your 7 Gleason score, was your score based on a 4+3 and not a 3+4?

      I ask because, based on what I've read, my dad is just beyond the point of requiring treatment. I recently read a book on prostate cancer, which was written by a urologist from John Hopkins, and it advises that AS should not be recommended with a Gleason score similar to my dad's.

      Thank you for your input here. I've been researching non-stop over the last 1.5 months, approximately, and find that hearing about other people in a similar boat and what they experienced to be extremely helpful.

    • Posted

      Sorry, Keith - I mean to ask above, "How long ago were you diagnosed?"

  • Posted

    As someone in the 70s whose had a radical prostatectomy - as well as my older brother - I'd be skeptical of such a strong urologist response without further information. Most urologists will say you have several options - surgery, radiation, monitoring - each with its own benefits and drawbacks. As one who had robotic-assisted surgery, incontinence was only a temporary recovery side-effect - which, according Johns Hopkins stats, is true for most patients. There is a risk of some degree of long-term incontinence for about 2% of patients.

    • Posted

      Hi rkwnyc, thank you for your reply.

      Can I ask what your Gleason score was when you were diagnosed, as well as your PSA results?

      How long has it been since you had the prostatectomy and how was your (and your brother's) recovery?

    • Posted

      My brother and I both had successful nerve-sparing surgery. My surgery was January 31 , 2019, and I'm back to normal. My Gleason was 4+3, PSA had jumped from less than 2 to 14+. My urologist said active surveillance was probably not a good option for me in light of my family history of aggressive prostate cancers - but that I had plenty of time to learn about my options. I finally went with surgery 3 months after my biopsy confirmation of cancer. Two of those months were evaluating the pros and cons of radiation and surgery. There's no right answer for everyone - it depends on what risks one feels best equipped to handle.

    • Posted

      Thank you for getting back to me, rkwnyc.

      I'm glad to hear you're back to normal. And I hope both you and brother are living happily and now cancer free!

      Can I ask how old you are? I realize you're in your 70's, but I'm just wondering about your exact age, mainly because I'm reading that surgeons don't recommend prostatectomies for anyone 75 and up, which is why I came here to see if anyone within my dad's age range has had a prostatectomy and if they had a good/bad experience.

    • Posted

      I'm 72. The specialists I talked to also talked about age, but not about a specific age; instead, my life expectancy - which, given my parents and grandparents, suggested a high likelihood I'd live into my 90s.

      Recent research now challenges the assumption that elderly men should not be considered candidates for radical prostatectomy. I suspect that, living in Manhattan and consulting specialists at research-oriented hospitals like Memorial Sloan Kettering, I was lucky to get very nuanced views.

      Here are two research links.

      Outcome of Robotic Radical Prostatectomy in Men Over 74

      Prostate Cancer in Elderly Men

    • Posted

      Thank you for this information, rkwnyc!

      At this point, my dad just wants the cancer removed. He doesn't want to deal with ADT (injections) or active surveillance - he just wants it gone. My family is anxiously anticipating the doctor's appointment tomorrow, as we get my dad's PSA test results back and we'll be discussing with the doctor exactly what can be done for my dad regarding the cancer.

    • Posted

      If he is going to have surgery, I would strongly recommend seeking a surgeon that specializes in prostatectomy. Ideally a surgeon associated with a teaching or research hospital and, these days, who uses the robotic assistance technology. Although I think robotic-assisted surgery has been oversold, it does seem to improve the chance of full success in the nerve-sparing aspect of radical prostatectomies. Good luck!

  • Posted

    Francesca,

    I am very surprised to hear about your urologists response to your dad's suggestion that his prostate be removed. As was mentioned previously here, the risk of permanent incontinence from RRP is low, but not zero. Statistics show that on the average it takes about a year to regain full continence after surgery, The second choice would be radiation, but that also has side effects. There is prostate swelling and that can be painful - I went into total retention for almost 6 weeks. Then, there are various choices of radiation treatment from brachytherapy, to external beam, to proton beam. The third choice is to do nothing - active surveillance. However, I found that AS kept me in a state of constant anxiety, so it's not for everyone. The fact that your dad is 78 means that his cancer is likely slow growing, so he would be a candidate for AS if he could handle it psychologically, but it doesn't sound like that would be good for him. It sounds like he just wants to get the cancer treated and get on with his life. If he chooses RRP then the skill of the surgeon is a factor. I have posted here before that if I had to do things all over again I would have gone for RRP rather than radiation, because after the radiation my prostate was still in place and tormented me for five years of BPH symptoms - still having some minor issues even after a recent TURP.

    Tom

    • Posted

      Hi Tom, good to hear from you in this thread! I appreciated all of your input and feedback in my other thread, so I'm glad to see you here.

      My dad is definitely leaning towards the radical prostatectomy and with the doctor's appointment looming tomorrow, where we find out my dad's PSA test results and discuss with the doctor what we'll be doing moving forward, my dad is scared beyond his wits for a couple of reasons:

      1. The unknown - we don't know the status of the cancer or if it has spread;
      2. If it hasn't spread and is contained to the prostate, my father is concerned that the doctor may refuse to remove his prostate (even though my dad is against any other form of treatment at this point). The doctor was against the idea of a prostatectomy when we were informed of my dad's prostate cancer back at the beginning of November. I'm not even sure if a surgeon can refuse to conduct a surgery like this under the circumstances.

      I hope you're feeling better soon, Tom!

  • Posted

    mydad was diagnosed would prostate cancer at age 75 he is now 84 and that cancer has not spread or gotten any worse. the doctor back then recommended a wait-and-see method or active surveillance where they keep an eye on the cancer by testing every 3 months and then every 6 months. this is very common for someone that age since prostate cancer is a relatively slow-moving disease. my dad's first reaction was to get rid of it and that is a very understandably common first reaction. the risks at that age for a prostatectomy includes permanent incontinence and bladder damage among other things. so you would be risking a major permanent quality of life change to get rid of a disease that the chances are you won't die of. there are many other problems you can die of when you are in your late 80s and 90s

    • Posted

      agree 100 % Mark. I was diagnosed 5 years ago at 3+4 which agreed is better than 4+3 but the crucial point is where the cancer is and how large

      AS has been fine for me

    • Posted

      Thank you for this, Triplets. Treatment for prostate cancer is so individualized. There's definitely no "one size fits all", so I'm glad to hear you have found what's worked for you. Yes, 4+3 is very different from 3+4, which is why I'm anticipating that the doctor will not recommend AS, which is fine, because I know my dad is adamant about wanting the cancer removed asap, that's if it is a possibility.

    • Posted

      Hi Mark, thank you for chiming in!

      The way you describe your father's initial reaction (i.e. - wanting the cancer removed) sounds exactly like my dad! This was my father's reaction as well, and his mind hasn't changed since his diagnosis 1.5 months ago.

      Can I ask what your father's Gleason score was and his PSA when he was diagnosed?

      I'm not expecting the doctor to recommend AS at this point, due to my dad's Gleason score, which is a 7 (based on a 4+3, and not a 3+4). When I read about the 7 Gleason score, I was blown away by the two ways in which the 7 score can be interpreted, with the 4+3 being considered much more aggressive and likely to spread than the 3+4.

      I do believe my father will need some form of treatment, and at this stage, my dad does not want injections or any form of radiation. There are some pretty intense side effects from the ADT alone, and it only delays the inevitable, based on what I've read. Furthermore, ADT is only effective in erradicating some cancer cells, not all, as some cancer cells are considered hormone insensitive and are therefore immune to hormone treatment. So really, this only leaves us with surgery. This is all of course, based on the assumption that the cancer is confined to the prostate.

    • Posted

      Mark,

      You say "keep an eye on the cancer by testing every 3 months and then every 6 months." I assume you are talking about PSA tests NOT biopsies, right? My second biopsy was brutal. Now that my prostate cancer has been treated, no more biopsies! PSA is at 0.2 and steady.

      Tom

    • Posted

      yes I was talking aboutPSI I'm not sure how often he has biopsies. FYI I had my prostate removed in 2016 at age 56. when you're that young the doctors recommend surgery more often than they do at age 79

    • Posted

      Mark, can you share your father's Gleason score and PSA at the time of diagnosis?

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