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User
Posted 14 Feb 2024 at 08:38

FOUR CHOICES ALL BOTH GOOD AND BAD
I am 81 in Newcastle Australia. I had OpenRP November 2015. No ADT or RT.  PSAa OK till
Jan 2021 0.02, 
Apr 2021 0.03 
Dec 2021 0.03, 
June 2022 0.06, 
Jan 2023 0.13,
Apr 2023 0.16, 
Aug 2023 0.32. 
PSMA detected PCa in node near tail bone. 
Urologist 1 recemmends ADT + SRT of node, 
Oncologist 1 wants ADT + SRT "the whole field". He feels there may be single PCa cells elsewhere waiting to be detectable. 
Urologist 2 (UK) thinks at 81 surveillance till PSA = 10.
Oncologist 2 wants ADT + SRT but excluding former prostate area, bowel and bladder areas. 
I have been incontinent for past 8 years which may have lead to the final recommendation. 


PSA went to 0.8 on 29 Jan 2024. 


2015 Surgery pathology:
Core biopsy Gleason score:  3 + 4 = 7
Prostate Measurement: 51x43x41mm
Prostate Weight:      63.5 grams (with both seminal vesicles and vasa deferentia attached)
Tumor Type:    Acinar
Tumor Extent:  Unifocal
Tumor Location:  Quadrants:  Left posterior
                            Zones:      Peripheral
Tumor Volume:  0.09cm3 (3D volume estimate method)
Gleason Score:  Primary grade   3
                Secondary grade 4
Composit Gleason Score (ISUP2005) : 3+4 =7
Index carcinoma score  (ISUP2005) : 3+4 =7
% High Grade (4/5)       45%  
DIAGNOSIS:  PROSTATE  - ADENOCARCINOMA


Does anyone have any thoughts.


If francij1 still a follower what's your situation after 27/3/23 PSA 0.086. We had some similarity. My Dad died in hospital having RT for bladder cancer of just 2 months. My PCAs began to rise 6 years after my 2015 Open RP. My GP referred me to Uro1 at 0.03. He said come back at 0.20. At 0.16 > 0.32 he sent me for PSMA and now 4 options


   

User
Posted 14 Feb 2024 at 12:49
My dad is older than you but had a recurrence at around your age. His PSA is currently around 2 but it is climbing quite slowly, the onco advised him that best prediction is it would kill him in about 25 years so he chose not to have any treatment at this point - he says if he makes 107 he will be happy! He just has a PSA test every year to check it isn't going sky high; if it started to rise rapidly or he has any symptoms, he will rethink.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 16 Feb 2024 at 00:39

It makes it more difficult to choose when you are offered the different paths that have been recommended and as Lyn implied age and QOL become increasingly more important factors to be considered and how you might be impacted at your age by the choice. Only you can decide knowing how well and active you were in the range of aggressive treatment to doing nothing active but be monitored if things develop soon and then reevaluate what might be your options at that point.


I have always fought to get the best treatment I thought possible but at 87 am conscious of the fact that I am wearing out and cannot do many of the things that I used to enjoy and those that I do I can't do so as quickly or as well. So I don't want to prolong my life in a more restricted way in order that I might live longer in a Care Home. So if my HIFU fails, I think I will not go for anything aggressive, even if that is a possibility, not even HT which will further inhibit my lifestyle.

Edited by member 17 Feb 2024 at 02:07  | Reason: spelling

Barry
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User
Posted 14 Feb 2024 at 12:49
My dad is older than you but had a recurrence at around your age. His PSA is currently around 2 but it is climbing quite slowly, the onco advised him that best prediction is it would kill him in about 25 years so he chose not to have any treatment at this point - he says if he makes 107 he will be happy! He just has a PSA test every year to check it isn't going sky high; if it started to rise rapidly or he has any symptoms, he will rethink.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 16 Feb 2024 at 00:39

It makes it more difficult to choose when you are offered the different paths that have been recommended and as Lyn implied age and QOL become increasingly more important factors to be considered and how you might be impacted at your age by the choice. Only you can decide knowing how well and active you were in the range of aggressive treatment to doing nothing active but be monitored if things develop soon and then reevaluate what might be your options at that point.


I have always fought to get the best treatment I thought possible but at 87 am conscious of the fact that I am wearing out and cannot do many of the things that I used to enjoy and those that I do I can't do so as quickly or as well. So I don't want to prolong my life in a more restricted way in order that I might live longer in a Care Home. So if my HIFU fails, I think I will not go for anything aggressive, even if that is a possibility, not even HT which will further inhibit my lifestyle.

Edited by member 17 Feb 2024 at 02:07  | Reason: spelling

Barry
User
Posted 18 Feb 2024 at 20:03

Hi,


It seems to me it depends how good you feel for your age and what your personal desire for longer life is.


Your psa is doubling roughly every 6 months so it could rise as below:  Your rate isn't fully consistent.


0.8   Jan 24
1.6
3.2  Jan 25
6.4
12.8  Jan 26
26
52 Jan 27
104
208 Jan 28


If you just had ADT it might hold out for 5yrs from when you start, say Jan or Jun 26, to Jan 31 when you'll be 88+.


On the other hand SRT might hit it harder and put it back more years.  Although it might have side effects.  The ADT might have side effects as well.  Your condition is critical to the choice.


If it was me and I felt in good condition at your age, I go to the gym and feel well, I'd look for SRT treatment at least.


All four options look reasonable depending on your expectation of life.  For me, I think the oncologists have it right and I think I'd want whole field.  Although your incontinence might be a big factor and it might make you double incontinent.  So there are risks.


I'm not an expert and these things are a personal choice.  But if I reach 81 I'll be looking to reach 90 and then 100.


All the best
Peter

 
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