Recommendation for my dad's prostate cancer treatment

[peacock20]

My dad is 80 years old with a cardiac history. He is taking medications for hypertension, diabetes and neurological disorders. During the TURP done recently he was diagnosed with tumour in the prostrate. Pathology indicated a Gleason score of 9. The pet scan has not shown any metastasis. Uro-oncologist recommended hormonal therapy and radiation. We hear both this will have serious quality of life challenges and will be great if we could get the views of the community

[Tall_Allen]

He may wish to see what this nomogram tells him, and make his treatment decision based on it:

webcore.mskcc.org/survey/su...

[Kai77 in reply to Tall_Allen]

Hi...allen..

I just want to ask ..

in your opinion, how accurate is the webcore nanograms?

[Tall_Allen in reply to Kai77]

Most nomograms have about a 70% predictive accuracy. What were his 15 year results?

[Kai77 in reply to Tall_Allen]

My father 15 years result are :

57 men would be alive

12 men would have died of untreated prstate cancer

31 men would have died of other causes..

How about that result allen?

[Tall_Allen in reply to Kai77]

So, how does that influence his decision?

[Kai77 in reply to Tall_Allen]

He had not made up his mind...

Due the covid19 ..we can not travel to singapore..

[Tall_Allen in reply to Kai77]

NCCN recommends treatment for high-risk patients whose expected survival is > 5 years. with radiation + ADT. Metastatic disease is painful and debilitating. He can get a shot of Lupron (or similar) and decide based on it if it would be burdensome for 18 months (they have to wait 2 months to begin radiation anyway). It may be a good idea to start that now (especially because it boosts the immune system) to prevent further spread while he decides. I had prostate radiation myself, and I would describe the side effects as minimal and temporary - but he is 80 and diabetic, so I would expect them to be somewhat more troublesome for him.

[Magnus1964]

Being diagnosed at 80 may not be that serious. He could go for the rest of his life without any problems. Gleason score of 9 is of concern. He could get by on ADT drugs alone. Start with casodex and see how it goes.

[noahware]

I agree with Magnus1964 that a milder hormonal approach of bicalutimide might be a good option for starters, at 80+ with other health conditions. Most men tolerate this drug pretty well, with fewer side effects and better QoL.

Other treatments could be considered to address pain/symptoms if and when they arise, but with no detectable mets there would not seem to be an immediate threat of the PC being highly lethal at this time. Immediate hormonal therapy should help delay that possibility. The idea of "cure" may sound appealing but that does need mean it is needed, even if possible.

[Hidden in reply to noahware]

I agree with this and also Magnus 1964.

I don't think it makes sense for someone who is 80 years old to take an aggressive approach (radiation or RP) when he could likely treat it with a less aggressive approach (ADT) and have a better QOL.

When it comes to prostate cancer in older men, there is often a tendancy to overestimate life expectancy and justify an aggressive treatment approach with more side effects.

He could easily manage this for the rest of his life with a minimalist approach while maximizing his QOL. In my opionion, he shouldn't be spending significant time dealing with the side effects of an aggressive treatment that probably won't add to his life expectancy.

[Hidden]

The best of luck to your father with treatments. Thank you peacock for sharing his story and yours with us ?😷🌵

[dac500]

Age can be one of the criteria in treatment decision. But it shouldn't be the only criterion. A man of 80 may live to be 100. A man approaching 80, I have been battling prostate cancer for 9 years. It started as Gleason 3 + 3 low volume cancer, which was initially treated with brachytherapy. Unfortunately, I had an extra capsular extension followed by metastasis to multiple abdominal and pelvic lymph nodes. Currently, I am on ADT vacation. But if my cancer takes the wrong turn, I wouldn't hesitate to consider aggressive treatment. We are sometime too quick to pass judgement on someone getting prostate cancer diagnosis later late in life.

[Hidden]

When you are looking at age, you also have to factor in the comorbidities when considering life expectancy.

If you run the nomogram above in TA's response, you can see how low his chances of dying from PCa are compared to other causes of death.

It's easy to overtreat someone in his situation with unnecessary, aggressive treatments and diminish his quality of life for nothing.

[Gearhead]

Age is certainly a factor to consider. But it goes both ways. For example, you are concerned about ADT side effects. Loss of libido is one of the biggest side effects for many. With many exceptions of course, this may be a bigger quality-of-life issue for someone 50 than someone 80.

[Don_1213]

Actually - the radiation may have only minor side-effects if done correctly. ADT is more likely to cause noticeable side-effects. He probably should talk to a radiation-oncologist, and a medical-oncologist.

[j-o-h-n]

Greatings peacock20 in India,

It is definately a hard call since your dear dad is 80 years old. If it was me I would do nothing and just live my life as best that I could. He would probably reach 90 years old and complain that his Red Lental Dahl is too spicy.

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 07/12/2020 2:21 PM DST