Treatment or wait and watch for 86 year old

[BaseCampGoal]

posting on behalf of my father who is 86 and lives in india. He has been having BPH for many years. Urinary Symptoms recently became worse and dr took psa (21)along with MRI.

MRI came back with PIRAD 5 and the” gland with extra capsular extension along the right lateral wall of gland with infiltration into right seminal vesicle and right neuro-vascular bundles “ As per MRI no pelvic issues seen.

Yet to see the dr after MRI. before MRI , he indicated that he will go radiation and/or hormone therapy route (and may also do biopsy if needed after seeing the mri results)

he has heart failure, diabetes (controlled) and hernia. His urinary symptoms are slightly better after changing the medication.

Should we take frequent psa test and if it starts increasing dramatically look for treatment or start the treatment immediately?

my biggest worry is that any new medication will cause lot of impact to his ongoing issues which are under control.

[Tinkudi]

I am in India too. Here for my dad who is 83. In Mumbai and you ?

[BaseCampGoal in reply to Tinkudi]

My father is in Chennai. Hope your father recovers quickly as well. I see that your father took Urimax D which contains dustasteride. How many years did he take it before his diagnosis?

[Tinkudi in reply to BaseCampGoal]

Almost 15 years

[witantric]

Is he fit enough to get a biopsy?

[BaseCampGoal in reply to witantric]

how would biopsy help drive the treatment? Is it the possibility that it may not be cancer? Could that be addressed by watchful waiting?

We were approaching the dr about getting RP before we suspected and Dr said it will be high risk surgery. Dr is pretty much wait and watch mode to even fix his hernia

[witantric in reply to BaseCampGoal]

True. I was thinking that he might get a definitive gleason score, but Tall_Allen is right. At his age, watchful waiting seems good. PSMA PET SCAN might not hurt to see if he has metastasis.

[GP24]

I would get the prostate radiated soon to prevent the onset of local symptoms such as bleeding, pain and urinary obstruction, which make the patients' live miserable. The oncologist has to determine if he is fit enough to get ADT.

[Tall_Allen]

IMO he should use "Watchful Waiting." That means, he will use hormone therapy when he starts experiencing bone pain. He may want to start on hormone therapy to shrink his prostate now to help with his urinary symptoms.

[BaseCampGoal in reply to Tall_Allen]

Thanks Allen for your reply. That is the direction i was leaning towards pending dr visit.

Dr recently changed his BPH medicine (3 weeks back) from Urimax 0.4 to combo medicine of silodine and dustasteride. This seems to have improved his symptoms where he feels flow is better.

Would watchful watching be primarily symptom based (like bone pain/ increase urinary symptoms) or based on regular PSA checking?

[Tall_Allen in reply to BaseCampGoal]

"Watchful waiting" is symptom-based only. It is the only thing recommended for men that have 10 or fewer years of life expectancy. It is entirely different from "active surveillance" that you may have heard about.

[Conlig1940]

First I am 84 + years old and I have been on Dutasteride for 4 years for my BPH . I also have Gleason 3 + 4 = 7 prostate cancer and am on Active Surveillance .

When you are on Dutasteride this long " YOU HAVE TO DOUBLE YOUR PSA READING " and on this drug long term , Multiply by 2 1/2 times your PSA .

Try and purchase Dr. Patrick Walsh's book " Guide to Surviving Prostate Cancer " and educate yourself . It explains and will answer many of your medical questions .

Finally . Always listen to your medical team , Urologists . Radiation Oncologists etc -- Your Tumor Board members -- NOT THE UNTRAINED MEDICAL LAYMEN , on this forum .

Our individual cancers are unique to us , similar to others yes . BUT NOT THE SAME .

[Tommyj2 in reply to Conlig1940]

Don’t know who this response is addressed to…..that said…why come on to this forum if the only considerations you consider valid are a book and each individuals medical team? There is a lot of good advice being offered by laymen on this forum……

[Conlig1940 in reply to Tommyj2]

Tommyj2

I follow this forum for fellow member experiences only .

Only fools follow laymens advice when it comes your health issues .

Show me an ethical physician who will diagnose a patient who they never met or know their family and personal medical history . And I will show you A QUACK .

Colleen Young will clarify the purpose of this forum for you .

It is NOT FOR UNQUALIFIED MEDICAL , Monday morning quarterbacks giving medical advice --- period ..

[Tommyj2 in reply to Conlig1940]

Who is Colleen young?….. AND I don’t note a lot of men changing their care plan based on the opinions of those on this forum. I DO see a lot of men learning good questions to ask of their medical team.

[CAMPSOUPS in reply to Tommyj2]

Thru the advanced forum found a member who seemed more concerned about espousing his material world credentials than joining out of concern for his prostate cancer which actually seems to be under active surveillance.

The member is not only a retired engineer he is a retired CORPORATE engineer. Not only is he a business owner he is a EXECUTIVE business owner. That stipulation is first and foremost in his bio. Prostate cancer comes after.

Oh well the nonchalant who cares conceited response I got to my question to him kinda falls into place with all that. "Simple -- I clicked on the link ...."

However his deleting his response to me seemed oddly cowardice.

I guess some on this earth due to their self awarded accolades are somehow better than the rest of us ?

[Tommyj2 in reply to CAMPSOUPS]

Don’t know why you are replying to me as I don’t recall getting in touch with you….if I did,my apologies. I don’t ,actually,understand your post.

[CAMPSOUPS in reply to Tommyj2]

Sorry yea in retrospect looks confusing.

He took issue with your comments and here we are in the advanced group and he seems to be under active surveillance. I guess I was just pointing out the source of the man who had issue with your comments.

Click on Conlig1940's name and look at his bio.

[CAMPSOUPS in reply to Conlig1940]

YOur on active surveillance? How might you have found yourself here on the advanced stage 4 forum vs. the active surveillance forum ?

[Gaden]

it sounds like your father has professional medical attention that is focused on him as an individual rather than simply as one more cancer patient. At that age and in his condition doing any sort of surgery can be riskier than the potential value. In my purely amateur opinion, hormone therapy started now would probably not have a huge impact on his quality of life but could head off further growth of tumors and pain.

[BaseCampGoal]

His Urologist prescribed bicalutamide and wanted him to to get his biopsy. (TRUS)

We are still ambivalent. Another urologist also recommended getting a biopsy. And then based on biopsy results, he would recommend either wachful waiting or surgical castration. Considering my father’s age he felt surgical castration would lead to better qol than medical therapy. He did say that u could potentially check psa levels/ US and watch, but that was strictly not something he could recommend officially based on MRI results

Would TRUS lead to using catether for few days? Are there side effects from such a biopsy?