PSA 43.7 - Is this very bad?

[mariacwelland]

Hello Everyone - my 90 year old father has a PSA of 43.7 - is this bad, or how bad is it?

What happens now? What questions should I ask?

Help please

Maria

[Dr_WHO]

Welcome to this sight. Hopefully you can get some answers here. First, while PSA is a good indicator test it is not perfect. There are people with low PSA but have advanced cancer. For example, mine was 4.7 when they found out I had advanced cancer. On the other hand, some conditions can raise your PSA quite high without it being cancer.

That said, a PSA of 44 requires additional testing. He should find an urologist that is familiar with prostate cancer and get a biopsy ASAP along with CT/bone scans. Even if the biopsy comes back positive, there is every reason to expect he would pass away from something else and not the cancer. Hopefully even if he does has cancer, the best treatment may just be to follow it by active survalence.

It is scary when you get news that may indicate a problem. However, as of right now it is just an indication. Let's hope for the best!

[AlanMeyer Moderator in reply to Dr_WHO]

I posted my reply without seeing Dr_Who's reply. I think he makes good points. If the only test done was a PSA test, then additional testing is needed. And it's possible that, in spite of the high PSA, active surveillance might be practical, though I'm guessing that some drugs will be worth trying.

Again - find the best doctor you can to get the best opinion.

Alan

[AlanMeyer Moderator]

Hello Maria,

A PSA of 43.7 is considered "high risk".

Your father has two choices at this point, one is to attempt a cure with surgery or radiation. Radiation would be a more likely choice at his age since it's easier to take and easier to recover from. The other choice is to attempt to control the cancer with drugs for which "hormone therapy" is usually attempted.

You'll need an expert (i.e., an oncologist) to render an opinion on which choice is better for your Dad, but I think that, at his age and with his high PSA, it is more likely that the doctor would recommend the drug approach.

What happens after that depends on how your Dad responds to the treatment. Some men get many years of symptom free life from the drugs (typically an injection every 3 or 4 months, or a pill once a day, and have few side effects. Others aren't so lucky. The same is true for radiation. With that high a PSA it is possible that the cancer has escaped the prostate and the radiation won't cure him, or it might all be in the prostate region and be completely destroyed by the radiation - with few side effects.

I think the best thing that the family can do at this point is to find the absolute best doctor for treatment. Such people are often found at the university teaching and research hospitals, but there are fine doctors elsewhere too. What you definitely don't want is someone who makes a lot of money performing this or that treatment and who just recommends that treatment to everyone. I suggest visiting at least a couple of different doctors, one of whom should be a medical oncologist who does a lot of treatment of prostate cancer and knows the current state of the art. A radiation oncologist who does a lot of prostate cancer treatment might also be a useful person to consult. Try to find someone you think is intelligent, caring, and knowledgeable.

My congratulations to your Dad for making it to age 90. I hope he gets many more years after - and I hope we all make it that far too.

Best of luck.

Alan

[mariacwelland in reply to AlanMeyer]

Dear Alan and Dr Who - I can't tell you how grateful I am for your advice and input - it restores my faith in Human nature. i will do all the things you advised. The worst thing when someone is ill is you feel so helpless - I have a direction now and will let you know how I get on

Regards

Maria

[jal1954 in reply to AlanMeyer]

I agree with this, but I'd recommend a major cancer center if possible. I'm a patient at MD Anderson, and I swear by it.

Concerning the PSA, I met a fellow here today who presented wth a PSA of 1400something. Crazy! But he's been treated, and I think he quoted a present value of sub-100.

Nothing more to present beyond what the others have said. Get the best experts you can find and spare no expense.

[aquaeyes5]

The PSA is a good indicator that his prostate needs further testing. 43.7 is quite high....However your father is 90! The psa in and of itself does not paint the entire picture. Get with a good urologist, have and exam, and if they determine his prostate is enlarged, they will want further testing. Probably a biopsy, bone and CT scans. His gleason score will be determined from that....that will give you a much fuller picture, about how to proceed.

[mariacwelland]

Thank you so much for your advice - you're really kind to have taken the time to help.

[David1958]

Come on guys, the guy is 90 years old. Do you really want to put him through the trials of treatment and recovery? Why even subject him to a biopsy? Leave him alone. He will in all likelihood die of something else. I think all of us here are spring loaded to do something, anything, no matter how invasive to get a grip on this cancer that is eating away at us. At 90, I would say look at your bucket list and if there is anything left undone, do it now. Screw treatment, it is not worth the effort, the anguish, or the pain and suffering. If it does get aggressive, get the best palliative care you can.

[DFZ4835]

In my investigation of cancer I have read and heard that most men after 70 usually have prostrate cancer and it is so slow growing it will not affect the man's longevity. Those men are put on active surveillance and watched closely. Find a good oncologist and let him or her determine the cancers severity.

Those of us on this forum have prostate cancer with metastasis. We are fighting for our lives and have the fight mindset. Maria don't panic . Find out what the oncologist thinks first.

I am sorry your dad and you are in this position. You are doing the right thing looking for answers.

Your friend Dennis

[mariacwelland]

Thank you Guys for your support and input. I'm inclined to agree with Dherberling.

I don't think my Mum who is 86 could cope with the stress of it either!

Regards

Maria

[ng27868168]

I agree totally with DHeberling. At the age of 90, any surgery or invasive treatment IMO is not going to make much difference for your dad. Odds are he has had some elevated PSA for years and at that age if he had prostate cancer, more than likely it is the non aggressive version. His comfort and quality of life is the #1 priority at this stage of his life.

[AlanMeyer Moderator]

Here's a few more comments.

If your Dad is in the U.S., the U.S. National Cancer Institute keeps a list of what they consider to be the best cancer research hospitals in the U.S.

See: cancer.gov/research/nci-rol...

These are places where the doctors keep up with the latest research and do some of it themselves. NCI said they average 20% better outcomes than community cancer centers.

The comments recommending against treatment at age 90 have a point however some treatments really aren't too bad. I'm thinking of a drug called Casodex that involves taking one pill a day. Some men don't like the side effects, some don't seem to be bothered by the drug. It's the kind of thing that a man can take once a day and, if it's not working out, just stop - something that isn't true of surgery or radiation.

Another drug called Lupron (and variations called Eligard or Zoladex) is injected. Usually it's a 3 month injection but short time frame injections are also available. I was given a one month injection to see if I tolerated it okay, then was followed with a 3 month injection.

In most men, either of these drugs or others like them will quickly stop the growth of the cancer and shrink any existing tumors, bringing the PSA way down. I know two men who used these drugs for more than 10 years without requiring any other treatment. Both are still alive and doing well.

A good medical oncologist who works a lot with prostate cancer will be able to balance drugs and side effects and can sometimes fix side effect problems very well. He'll also be able to render a more expert opinion than any of us can about whether treatment is desirable at all. He might just recommend active surveillance (usually means getting a PSA test at least every 3 months and may involve other scans or tests.)

Best of luck.

Alan

[ng27868168]

Alan Meyer makes some legitimate comments, but there are and can be side effects to these drugs such as Hot Flashes, loss of energy, sleeplessness, etc. This is where "Quality of Life" issues come into play with any serious illness. IMO, at age 90 quality tops quantity. But everyone has to make a choice. God Bless.

[ajkkim]

You will get many different opinions about this, but at age 90 prostate cancer is not going to cause his death. His PSA is high and likely does confirm his cancer. Mine was 55 when i was diagnosed. Being practical, unless he is having significant symptoms, I would care more about his quality of life in his time remaining and forgo the treatment doctors are obligated to recommend.