Watch and wait versus hormone therapy

Dear Carol

I am sorry to hear of your father's predicament.

My Background:

I am 50 and was recently dx'd with a Gleason 9 and opted for RARP. 4 months on I feel pretty damn peachy. No pads and almost pre-RARP bathroom visits.

My advice, as a patient, which most men in the room are:

I agree 100% with Rodgerdodger and with romneyj's statement on outliving the cancer given there is no evidence of metastastis to the skeleton or node involvement. 

Sure your Dad is anxious. Who wouldn't be? And he wants a plan of action. I agree. BUT that is not synonymous with aggressive treatment.

I like what you were told by the urologist: to recheck the PSA in time. If he wants to feel on top of issues, then you can have him check the PSA in 3 and not 6 months.

Also, when you mention his nominal PSA level, note it is the change over time i.e. the velocity that matters and not the no nominal  number. In his case you offered only one number so we can't infer the significance of that number because folk can have PCa with a PSA of 1 and others can have no PCa when their PSA is very high.

If in 3 months the PSA has climbed significantly ( note the rule of thumb is a doubling in one year means PCa in most cases) THEN he could actively inquire about Radiation. I would keep away from hormone therapy if possible.

Best wishes. Please keep us informed.

I work at Procure Cancer Center in Oklahoma City. I am 78 years old and went through proton therapy almost 6 years ago. My PSA was only 4.2 when my urologist discovered a small lump in my prostate through a rectal exam. After a biopsy it was determined that my gleason score was 7. Fortunately, it was caught in time and I am 6 years out this April with no side effects. As a past patient and as a patient transport, among other duties, at the Cancer Center I have the opportunity to talk to many patients. Those who have waited too long totally hate having to take the hormone treatments. I suggest you go online to Procure Cancer Center, read about proton therapy and even talk to one of the intake nurses which can put you in touch with one of the Dr's. on staff. The educational benefit might prove valuable to you. Wishing you the best......................

Hi Carol, Your Father's MRI said there is evidence the PCa has left his prostate and invaded one of his seminal vessels. It has a Gleason score of 4+3, meaning it is not to be ignored, even for an 82 year old. The PSA is sort of useful, but you need several earlier ones to form an opinion/graph of the PSA increase over time. The MRI gives you a PIRAD score and staging what was his?

Thinking these days is a 82 year old just diagnosed with PCa will probably decease from something else other than PCa. Yeah, well, these days a otherwise healthy, fit and active 82 year old could still have 10+ years. The medical profession prefer hormone treatment to avoid surgery due to the age of patient.

Sure, your father could 'wait' to see if his prostate cancer became a problem, but maybe not to good for his state of mind. Some people are ok with AS, some are not and are of the 'get it out of me' type. Others ok to retain prostate, but some sort of action to kill it within the prostate. 

From what I have read, hormone therapy can be a life changer for some, and not a positive one. Many senior guys refuse a subcapsular orchiectomy (castration) as not manly, but maybe better quality of life than hormone therapy.

After watching my very fit and healthy 75 year old Father in law die from PCa, a few months before the end, he said if he had his time again, he would not have agreed to AS, and later hormone therapy, but have had Brachytherapy or radiation. He had refused an orchiectomy. In his case, the cancer was reported as 4+3. When it did escape, it went straight to his brain. His PSA initially was slowing, but then was doubling every 6 months. In the last year, it went vertical.