My 82 year old dad has been treated by his urologist for an enlarged prostate for about 10 years. About 8 months ago, his PSA level rose to 8.5. A subsequent biopsy showed prostate cancer (not the cause of the enlarged prostate).

Because of my dad's age, the urologist felt comfortable to "watch and wait" for six months. The latest tests came back at 12.5.

The urologist is recommending a five-seven week series of external radiation treatments, five days a week.

My dad is in remarkably good health, but he (and we) have gone through a lot in the last few years to get to where we are today. He has Normal Pressure Hydrocephalus. For years it went undiagnosed, and he had problems with balance, mild dementia and urinary incontinence. He had shunt surgery 2.5 years ago and, although he has almost no short term memory, he is once again physically and socially active. He walks three miles a day, handles his own business, has no incontinence (unless he has a urinary tract infection).

As long as he gets proper rest during the day, he feels very well and his neurological symptoms are minimal. If he is tired or sick, all of his symtoms start to reappear.

He is reluctant to have any treatment, because he's afraid that he will lose the health and independence he enjoys now. However, his doctor feels that he no longer has the option of "watching and waiting".

I'd love to hear some opinions about treatment of elderly patients with best outcome and fewest side effects. Does he need to see an oncologist, or is the urologist the proper specialist to recommend treatment? His cancer seems to be in the very earliest stages, but he may live many more years. Needless to say, we want him to have excellent quality of life.

I wish I knew enough about this to help you, but I do not. The only thing I would suggest is to get second and third opinions. I fully understand that quality of life is a main concern for him. Keep us posted.

Peg

I agree with Peg, you need a second and maybe even a third opinion. I also have an 82yo father (no prostate cancer though) so I can understand you wanting the best treatment options especially for his age.
My fil is 66 and currently has adv. prostate cancer and he is treating with his urologist but has also seen a radiation oncologist and is probably going to seek another opinion from a medical oncologist.
You need to ask questions and seek answers to find the best choice for your father. You need to know if his cancer has spread outside his prostate or not treatment varies according to the extent of cancer and also on life expectancy.
My 71yr old neighbor was dx'd with pca this yr and they did the watchful waiting until 3 months later his psa increased and his cancer had grown, they then removed his prostate, I think his gleason score was a 7 and psa was something like an 8, he had sought out 3 different drs because he told me the first two did not want to do a prostatectomy on someone over the age of 65yr due to increased post op complications.


Good Luck to your father.

Thanks for the replies.

If I could convince my dad, I would have changed urologists ages ago. *I* think he's passive to the point of disinterest, especially since I had to call five times last week to find out the test results from Sept. 21st. I can't imagine where they have been all this time.

I think we'll go ahead with the first appointment with the radiation oncologist. All we know at this point is that six months ago, his PSA was 8.5, and the biopsy was positive for cancer. Now his PSA is 12.5. What we need to know is what it looks like, and the initial scans should tell us that. His urologist feels that it has not spread.

With an elderly patient, I think the doctors always weigh life expectancy with aggressiveness of treatment. My dad is 82, so he probably will only live another 6-10 years, if that (he hopes he dies in his sleep, of course!). If the external beam radiation can stop the cancer for several years with temporary mild side effects, the doctor feels that we can take this off our worry list.

I'll keep you posted!

Hi Pat S,

I just wanted to tell you about my FIL and my father. They both have/had prostate cancer.

My father is now 78. When he was about 74 (?), he had prostate cancer. He and his doctor decided on radiation treatment. It cured (?) it and he is fine as of right now, except that he has alzheimers and parkinsons. Just no prostate cancer. But he did just have a urinary procedure. Greatly enlarged prostate amoung other things, urinary.

My FIL is now 90. About 1 1/2 yr. ago, he was diagnosed with prostate cancer. He had a hormone rod put in his arm. A few side effects that did not last long. That worked for 1 yr. Then they put in a new one. I expect it to last 6 - 9 mo. I have read that each hormone rod after the 1st and 2nd and so on - do not last as long as the one before. But he feels great and dances and such. We hope he dies in his sleep or outdoors. He has bad heart disease too. Cross my fingers.

I hope that you do get at least a 2nd opinion. I do know that most doctors treat older prostate patients with watchful waiting. It is - how much pain do you want your father to be in? Most prostate cancers, are supposed to be slow growing?!

Take care and good hunting. Wannabe

Thanks, Wannabe,

The urologist feels that, since my dad may live for years longer, the hormone therapy would just be a bandaid. We were hoping that his would be slow growing, but his PSA went up 50% in 6 months. I think we'll listed to what the radiation oncologist has to say after seeing his scans, and get a second opinion if we're not sure. My dad's resigned to temporary discomfort, but he realizes that he could be faced with serious consequences without treatment.

Just curious - are you sure your dad has Alzheimer's Disease and Parkinson's? Did they do MRI & CT scans? Lots of people diagnosed with AD and Parkinson's (or that vague "dementia" which means nothing) really have other things....like Normal Pressure Hydrocephalus. My dad was undiagnosed for years.

Ironically, since most people (men and women) who have urinary incontinence see a urologist, it's the urologists who seem to know nothing about this condition. Every time we go to the urologist, my dad and I look around the waiting room and wonder how many elderly patients in that room have NPH.

Pat

This is just an update.

We met with the radiation oncologist today. I was very surprised to learn that my dad's Gleason score at the time of his biopsy in March was 9. I'm baffled that his urologist told us that we could just watch and wait for six months, since it clearly is a fast growing cancer. I can't figure out what he thought it would do in six months besides *grow*.

Based on all the information, including CT scans done today, the oncologist concurs with the urologist's recommendation for the external beam radiation (no seed implants).

The needles they use to implant the seeds cause swelling, and my dad's prostate is so large (4 times the normal size), he doesn't have room for swelling. In fact, the doctor seemed shocked by the size of his prostate and exclaimed, "Your prostate is HUGE!". My dad said, "Thank you." ;-)

We return next week to set up his treatment schedule, which will be five days a week for about eight weeks...straight through the holidays.

Pat,

I can't believe the dr was wanting to "watch and wait" on a fast elevating psa with a gleason of 9. Did your dad's ct scan show any growth beyond the prosate? hopefully he had a bone scan done also. Take note your dad's case sounds very similar to my fil's, large prostate, fast rising psa, gleason of 9, my fil's ct showed questionable lymph nodes so his is already outside the prostate, he did the 43tx's of radiation but it was not with curative intent and he is doing hormonal therapy, next step will be chemo probably if and when the hormones stop working. My fil is 66yrs old.

Prayers and positive thoughts for your dad

A.

He sounds just adorable. You need to research and find out if this is a very slow growing cancer. I think it is. Leave the sweet man to live in peace and keep him away from the money grubbing butchers. I've always heard that a man will die from something ELSE before this gets him. A huge percentage of older men have prostate cancer and just ignore it. If he were 40 my reply would be entirely different.
He sounds like a very wise man .

At the time of the biopsy (March 2005) we were not very well educated on prostate cancer. I'd heard so many times that in elderly men it's usually a slow growing cancer, and that's what I believed.

When the urologist told us that some cancer was found (not related to the enlargement of the prostate), we asked about our options. He said that he could have hormone therapy, or external beam radiation therapy, or just "watch and wait" and check the PSA in six months. Of course, my dad chose that option.

It took me a month of phone calls just to get the results of the recent PSA test. The urologist was still very casual and laid back about it, and it makes me wonder if he doesn't know how to read these tests OR if he thinks elderly men shouldn't be treated.

The CT scans didn't show any spreading, and nobody has suggested a bone scan (it's on my list of questions). Maybe that's best to be done later, since radiation will (we hope) at least slow down or stop the exisiting cancer. Whether or not it's in the bones, I think radiation is still needed.

I can't believe we have lost all this time in getting second opinions and starting treatment. Now, we'll be going straight through the holidays and the end of the year with daily radiation. I'm REAL concerned about my dad having to drive himself much of the time, especially in holiday traffic (we all work).

I'm trying to get copies of the pathology reports and the PSA tests, and it's like pulling teeth. :-( (Sad and mad)