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

Francesca,

Well, a PSA of 1 is very low and certainly good news. It is surprising that any cancer was found in the first place - goes to show how poor PSA is as a marker for cancer. I completely understand your dad's anxiety - had the same myself. Went on AS for a year and a half. PSA was in the 4-5 range and didn't change, but the second biopsy showed "progression" so I decided to have radiation. I was just not comfortable on AS - some here do just fine. I was 66 at the time. I understand why your urologist doesn't want to do the RRP because the older the patient the more likely it is that there could be issues - so he's probably trying to avoid some problem that might happen. General anesthesia does have some risk and the older the patient the less doctors want to use general. Since you now have time I would think you should get a second or third opinion. Check with Dr. Samadi in NY, check with the Cleveland Clinic, Johns Hopkins. You will find that each doctor will have a different specialty and a different approach to the issue. I consulted with four different urologists before moving forward with treatment. They pretty much think that their way of treating the cancer is the best. You have to learn to read between the lines.

Tom

I strongly second Tom's recommendations!

Hi Tom,

I know! We truly were baffled by the PSA results, considering my dad's Gleason score. The book that I'm reading, "How to Survive Prostate Cancer" by Dr. Patrick Walsh advises that active surveillance should NOT be recommended for someone with a Gleason score of 7. It's frustrating because I've been researching and reading tons about prostate cancer, and when what I'm reading doesn't align with what the doctor is telling us, I then wonder who to believe and where to turn. I spoke with my dad about getting a second and third opinion, but I'm not sure if he will. He was pretty relieved when we left the doctor's office yesterday, so having to discuss with him what I've read about prostate cancer, particularly things he does not want to hear, is extremely difficult. I feel like I have to be honest with him, but I don't want to send him into a psychological downward spiral. It's a tough line to walk, needless to say.

Francesca,

Dr. Walsh is THE expert on the subject, so if he say no AS for Gleason 7 he means it. PSA readings are almost meaningless. There are many here on this forum that have high readings and no cancer - just enlarged prostate. Your dad isn't a good candidate for AS anyway - too much anxiety. So, either he agrees to some form of radiation or proton beam or focal therapy, or you find a urologist willing to do a RRP. If your current uro won't do it then you really have no other choice other than to find a great uro who is willing to do the operation on a 78yr old. You are doing everything you can. If none of the uros will do the removal then there is no other choice other than some form of radiation - it's basically painless and easy.

Tom

Hi Tom,

I've been in touch with another urologist who suggests that my father needs a new doctor and that he should be undergoing some form of treatment, regardless of his PSA results (although great news in terms of the low PSA test results). At the very least, my father will be seeking another opinion, which is great.

I'll be interested in hearing what this other doctor has to say. For all I know, they may agree with his current doctor's suggestion regarding active surveillance. And the thought of my dad going through such an intense surgery (and the side effects, after the fact) makes me nervous. I don't know if my dad is aware of the seriousness of the surgery and how it can affect quality of life. Although, he has mentioned that he doesn't give a dam* about incontinence (and other things) if it means getting rid of his cancer altogether.

And in terms of Dr. Walsh, I understand that he is a renowned expert when it comes to dealing with prostate cancer and I really found his book informative and helpful. I found so much of the information in his book interesting, including his conclusion that as a man gets older, the prostate cancer is more aggressive. Meanwhile, I've heard the opposite! Even on this forum it's mentioned that the older the person when diagnosed, the slower growing the cancer. I'm not sure what to believe at this point, to be honest.

Hormonal injections or ADT is also frowned upon as an initial form of treatment by Dr. Walsh because it's only delaying the inevitable or the progression of the cancer, since some cancer cells are hormone-resistant and remain unaffected by hormone related treatment. Apparently it's recommended that ADT be used in addition to radiation. Meanwhile, ADT is what has been referred to by my dad's doctor over and over again.

This is all so overwhelming! At the end of the day, it will be my dad's decision.

However, when I told him today, reluctantly, that another reputable local urologist is recommending he find another doctor, it really hit him hard. It was difficult for me to raise this with him - the fact that everything I was reading didn't align with his doctor's advice, and now another doctor is suggesting that my dad should be seeking another opinion (or doctor) altogether.

My dad was finally feeling good and happy, and then I came along and dropped a reality bomb. It wasn't easy.

I just hope dropping this reality bomb was worth it and that I'm not making things worse...

Francesca,

You have no choice other than to get a few more opinions. You will find that different doctors have different ideas about how to treat or not treat the cancer based on their specialties and experience. It's not at all like just going to the dentist with tooth pain and getting the tooth pulled or filled. One of the reasons I decided to get treatment was because I was just getting emotionally exhausted reading about all of the different treatments and opinions. Right now you are headed down a clear path - RRP from a top surgeon who has the confidence that he can help your dad. Of course, it's possible that one of the doctors will convince him to go for some form of radiation. That would be a lot easier. You should talk to doctors who do brachytherapy, and external beam radiation. I went to a brachytherapy class where they took our group on a tour of their facility and showed us a video of the procedure. Very interesting. Once you speak with at least two more doctors you will begin to feel you know what to do.

Tom

I can completely understand why you felt emotionally exhausted. It really is taxing! There's so much information out there, and I've read so many different things, it's hard to know what information is the most reliable and accurate. And it's frustrating when my father's doctor is telling us something completely different from everything that I'm reading.

At this stage, I think we will be lucky to even get my dad to obtain a second opinion. I doubt a third or fourth opinion has even crossed his mind to pursue, even though I mentioned it.

At the end of the day, I realize I've done everything that I can do. It's in my dad's hands now and I told him this.

but surely the age is very relevant . Its obvious than anyone younger than say 65 should be operated on or have some other treatment but i can well understand why someone of 78 would be put on AS .

as mentioned earlier,I am 77 and have been on AS for 5 years even though my original urologists suggested radiotherapy. i had 5 different opinions in two countries, and 4 of the 5 agreed that AS was sensible at my age .

I can completely understand why you decided to opt for AS, triplets. With respect to my dad, his Gleason score is different from yours. Yes, it's 7, but it's based on a 4+3, and not a 3+4. Therefore his score is much more aggressive and likely to spread.

Further to this, my dad has done absolutely no research regarding prostate cancer and treatments, and has only talked to ONE urologist.

He isn't doing his due diligence, in my opinion. If he talked to a few specialists and based on their advice decided that AS is the right option for him, then great - I'll support his decision. But at this point, because what I've read and researched is causing me to question what his current doctor is advising, until my dad speaks with at least one other specialist, I will continue to question whether AS is the best approach for my dad's cancer at this time.

Furthermore, I have been in touch with an expert urologist who also thinks that my father "needs a new doctor". So, until my dad meets with an oncologist who specializes in prostate cancer, and gets advice on what to do, I will not feel comfortable my father's current doctor's advice.

100% agree Francesca. seek another opinion. Although mine is 3+4 it could just as easily be 4+3 in another sample. It would not change my opinion at my age

Good luck whatever your Dad decides

Hi Mark, oh, okay. Without knowing your father's PSA and looking at his Gleason score alone, I can understand active surveillance in terms of a Gleason 6 (3+3), but this is VERY different from my dad's Gleason score, which is a 7 (4+3). The bugger about a 7 score on the Gleason scale is that there are TWO different ways the 7 score can be based on - either a 3+4, or a 4+3. The 4+3 is what my dad has, and it is MUCH more aggressive and likely to spread than a 6 (3+3) and a 7 (3+4). I'm glad to hear your father is doing well, though. Wishing you and your father continued success on your cancer free journey!