84yr old with PSA of 33. Help Please.

[skinnerst]

84yr old with PSA of 33. Help Please.

Hello all. I am 84yrs old with an airway disease and IBS attacks. I saw the urology doctor who was keen for me to have bone scan Xrays and later prostate biopsy. I don#t really have many symtoms of urinary problems (PSA done on a whim, not because of any problems) I am fairly active (cyclist etc and am self caring in all activities) Problem is that should I enter into all the Xrays/Biopsies route or stay away hoping that I may have few years left in my present state. I find I seem to swing between the two answers, and as such cannot come to a conclusion. I am going to have to come to a decision within the next few weeks. So please you experts I am lost in confusion.

[Garp41]

Where are you located?

[skinnerst in reply to Garp41]

West coast of Wales, UK.

[Garp41 in reply to skinnerst]

I'm in USA, but familiar with Mark Emberton, who I believe is in London.

He is supposed to be big in focal therapies.

You could do a consult with him.

[MelbourneDavid]

I'd say a bone scan is not a bad idea, to see if you're likely to have painful trouble from it soon, and if that is clear or at least in places that are non-critical (not the spine or hip) you could consider doing nothing until you have noticeable symptoms. At 84 a biopsy and most interventions risk being more trouble than benefit.

[skinnerst in reply to MelbourneDavid]

Most people seem to say at least have the bone xrays and either stop there or decide next step. Thank you

[Twobins]

My dad was 76 when diagnosed. PSA in the 900s. As he had COPD they decided on no biopsy and gave him hormone treatment which seemed to do what was required of it. He died when he was 84 from COPD. From what you're saying you're active and in good health with no apparent ill affects from the PC. As a cyclist your PSA will be elevated. I'm 58 and have a PSA of 4.7. Had my biopsy a couple of weeks ago which confirmed stage 1 PC with a Gleason of 6. I'm on active surveillance. As far as the biopsy was concerned it was painless only very slight discomfort and was over in a jiffy. Easier than having a filling at the dentists! It wasn't embarrassing and I wouldn't be worried if I had to have another tomorrow. Whatever you decide to do, good luck.

[Desanthony]

Hello, I live in West Wales too, near Dale on the South West Coast. Where are you? I tried to write a reply earlier but lost everything so here goes again!

I would definitely go for the scans and biopsy. I am 73 had a PSA of 12.9 and after a trus biopsy a gleason score of 7 (3+4) and a staging of T2 , however, after MRI a bulge was seen on my prostate (possibly the cancer "breaking out" so the oncologists changed the staging to T3 but urologist says T2b but T3 disease cannot be ruled out! The best way is to get an MRI first - I wish I had known that then but you learn things as you go along with this. You don't have to have any treatment even after the scans and biopsies but at least you will know what you are dealing with. I believe that due to nothing being visible in lymph nodes etc at MRI I was not offered a bone scan but wish I could get one but everyone still says I don't need one. After a lot of consultations my urologist and I decided that a robotic radical prostatectomy was not right for me due to pre-existing conditions of overactive bladder (suffered from this for decades) and a history of anal fistula from an infection 10 years ago and it was thought an rp would make these much worse and possibly make me doubly incontinent - though I know others with no pre-existing conditions have had a brilliant outcome from rp. We settled for hormone therapy for 6 to 8 months followed by radiotherapy and more hormone therapy. I am 4 months into my hormone therapy. Just before my second hormone injection my PSA was down to 2.3 and testosterone down to 0.1. I do get some fatigue but like you am fit and very active and go to the gym at least 3 times a week and look after an acre of garden with 100 trees and shrubs. I find the exercise helps with the feeling of fatigue and it has not really changed my work out - though I often do less because of other things happening in my life and not having time!

Definitely have the scans and biopsy so that you know what you are up against. Make sure you have antibiotics before and after your biopsy to avoid any chance of infection it does sound like not all are given this but I was and really had no problems at all. I don't think I was in the room for half an hour altogether a little uncomfortable for me but that was all.

All the best and keep in touch.

Des

[skinnerst in reply to Desanthony]

I live in Aberystwyth, which has very meager resources. we rely on visiting Urologists. si I guess I will take the bone Xrays and go from there. As I live on my own I do tend to worry more than most people do with families. I have 3 sons (living away) but have not mentioned anything to them until I know more myself. I am going through a flare up of IBS which can be painful just by itself, but hey ho. if the option is dying in pain because of my refusal to start treatment, I guess I will go with what the Consultant wants me to do. Thank you for your input. PSA is 33 at the moment

[Desanthony in reply to skinnerst]

Love Aberystwyth. Have lovely memories of the narrow gauge railway and lovely walks at Devil's Bridge. Must visit there again as it has been a long time since I was last there. Understand how the worry is more for you as you live alone. I agree with your not telling too many people until you know the full score that is exactly what I did. When you do tell your sons make sure to impress upon them the need for PSA tests to catch things early when they are curable. I know a lot of Docs avoid telling you about the test and a friend of mine just a few years younger keeps getting told he doesn't need a test because the last test was so good but his wife ensures he has a test every year to make sure it stays that way.

All the best.

Des

[tonygla in reply to Desanthony]

Hi skinnerst I apologize for my late reply as I have just read your post. You should contact your local Maggie's Center for advice and support they have staff who were N H S cancer nurse specialists and they give support good advice also contact McMillan Nurses for advice and support.

[Desanthony]

Hello, I live in West Wales too, near Dale on the South West Coast. Where are you? I tried to write a reply earlier but lost everything so here goes again!

I would definitely go for the scans and biopsy. I am 73 had a PSA of 12.9 and after a trus biopsy a gleason score of 7 (3+4) and a staging of T2 , however, after MRI a bulge was seen on my prostate (possibly the cancer "breaking out") so the oncologists changed the staging to T3 but urologist says T2b but T3 disease cannot be ruled out! The best way is to get an MRI first - I wish I had known that then but you learn things as you go along with this. You don't have to have any treatment even after the scans and biopsies but at least you will know what you are dealing with. I believe that due to nothing being visible in lymph nodes etc at MRI I was not offered a bone scan but wish I could get one but everyone still says I don't need one. After a lot of consultations my urologist and I decided that a robotic radical prostatectomy was not right for me due to pre-existing conditions of overactive bladder (suffered from this for decades) and a history of anal fistula from an infection 10 years ago and it was thought an rp would make these much worse and possibly make me doubly incontinent - though I know others with no pre-existing conditions have had a brilliant outcome from rp. We settled for hormone therapy for 6 to 8 months followed by radiotherapy and more hormone therapy. I am 4 months into my hormone therapy. Just before my second hormone injection my PSA was down to 2.3 and testosterone down to 0.1. I do get some fatigue but like you am fit and very active and go to the gym at least 3 times a week and look after an acre of garden with 100 trees and shrubs. I find the exercise helps with the feeling of fatigue and it has not really changed my work out - though I often do less because of other things happening in my life and not having time!

Definitely have the scans and biopsy so that you know what you are up against. Make sure you have antibiotics before and after your biopsy to avoid any chance of infection it does sound like not all are given this but I was and really had no problems at all. I don't think I was in the room for half an hour altogether a little uncomfortable for me but that was all.

All the best and keep in touch.

Des