Anyone have experience with surgery over 70 years old ?
He is Gleason 9 and potential seminal invasion and lymph node involvement but not 100% confirmed yet on PET or Bone scans.
My relative who is 72 was told by his urologist they do not advise surgery on anyone over 70 years old, usually only under 70 for surgery. I did have a relative that is 66 have surgery and doing fine.
If he has local extension to the seminal vesicles and local lymph nodes, discuss having radiation to the prostate and whole pelvis radiation plus 2 years of ADT and abiraterone.thelancet.com/article/S0140...
I was 69.5 at the time of RALP. During the stay in the hospital I met another man that looked doing ok despite his younger female companion (daughter/wife?) being very concerned regarding his age. Her words: "Mine is old, he is 75"..
Even if he wasn’t 72, radiation is a far better option. Surgery has worse outcomes in terms of cancer control and toxicity.
I thought Kishan reported, or maybe another study?, that surgery and radiation + ADT are very similar, but brachy boost the best in "cure" but not for side effects? This for Gleason 9-10? Or is it one of radiation options because of possible SVI ?
That is not what Kishan reported.
I meant this study...
jamanetwork.com/journals/ja...
Seems to me brachy boost clear winner , and the other 2 similar ?
Your reading of the study?
Diagnosed December 2019. PCa confined to prostate, Gleason 9, PSA 15, age 75.
Original urologist stated no surgery afire 70. Second opinion at NYU. Urologist there stated, no written rule, prefer not to do surgery over 70, depending upon patient. Went to Europe for third opinion. Urologist there stated, prefer not to do surgery after 70 depending upon patient. Also stated, I was not a good patient for surgery.
States recommended 45 radiation treatments, her seven treatments. Asked urologist here, why difference? He stated States want the nonet, here they treat the disease. Stayed here and still remain here. For me, a better life with less stress.
I was 75 and was told the same thing by my urologist; however when I met the surgeon he had me take off my shirt and said he'd rather operate on me than a fifty year old with a pot belly. He did. I am as of yesterday four years post-op. PSA non detectable
I had a salvage PT at 72 after proton radiation therapy failed 3 years later. I am now 84 years old. Currently on elegard (9 years) and erleada (5 years). I am completely mobile. My gleason was 7 4/3. Current PSA is undetectable.
Age can play a role, but it is minor. Someone telling you that surgery is not recommended over the age of 70 is just wrong in my opinion. You cannot and should not make a blanket statement like that. There are a variety of factors that determine the plan of care for a patient. We have done surgery on men over 70 hundreds of times in my career.
More expeienced guys here can correct me if im wrong, but...
I would put more emphasis on selecting your path based on probability of cure rather than how old you are.
Go to the internet and search Dr Peter Grimm. Pull up his charts and study.
I could be wrong but i think gleason 9 puts your relative in the high risk category. Looking at the high risk chart, surgery provides maybe 50/50 chance of cure?
Adt/Ebrt/brachy is significantly higher.
I concur with TA's comment above. I had a RALP at age 70 because the doctors thought the cancer was both very aggressive and still confined to the prostate. They were wrong about the second. It had already spread to the lymph nodes. If I had known that, I never would have had the surgery. I have had many difficult side effects. In your relative's shoes, where they already suspect it has spread beyond the prostate gland, I would definitely choose radiation.
thank you
Just to answer the question, not remarking on what probably should have been done had we been well-enough informed, my husband had a robotic simple at a couple of months short of 72 and a robotic salvage at a couple of months short of 75. He did extremely well, went back to work day 5 after both surgeries. The robotic simple was for BPH, not cancer. Biopsies for 11 years prior to simple were negative. He did end up doing 2.5 years of Casodex (already dealing with cognitive impairment) and 39 salvage RT to the prostate bed.
thanks - is the cognitive impairment mostly memory of events or more severe confusion ?
My advice - do not have surgery if you have high grade PC at Gleason 9. I was over 70 and surgery was not even considered due to the risk so I went straight on ADT, followed by Brachy followed by EBRT. Approaching 2yrs now and my PSA consistently at 0.008. Two more ADT implants to go, then it is a wait and see. I recommend my approach. Good luck.
did you have any spread or issues with seminal vesicle invasion, or lymph nodes ?
Raising PSA with 6 months of RALP
Ten year battle is over.
Can a 60 year old have an undetectable PSA?
The wait is over, surgery completed 12/18
PSA 70 & Gleason Score 9
