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Diagnosed. MRI Scan Competed. Recommend Treatment received. So what do we do now?

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User
Posted 27 Mar 2017 at 14:59

Dear Forum

Firstly thank you for being there.

My father is 81 Years old and in good health generally.

Following a TURP in Decenber 2016 20% of the shavings were found to be cancerous.

A Gleeson score of 3+4 was given.

A PSA test showed a level of 5.7. A Testosterone showed a level of 7.25 

An MRI scan followed and the results show that the cancer is organ confined (T2, No, No) (there is no evidence that it has spread beyond the prostate). We recognise that, relatively speaking, we are very fortunate and are thankful.

The team at the hospital have recommended a PSA Test every 3 months - but to 'save' hormone therapy or radiotherapy treatment for later should it be necessary. This might be defined as 'Watchful Waiting' I think. 

We have joined the local cancer support group.

My father's dilemma must be a common one on this board.

To wait and watch, avoiding the side effects of treatment or to act quickly to reduce the cancer whilst his health is good.

I would be very interested to hear the opinions / advice of anybody here who can spare the time.

Many Thanks

User
Posted 28 Mar 2017 at 08:47
Hi

I can certainly spare some time for you and although not qualified to give advice I will happily give an opinion.

I think your team are right to advise monitoring through PSA tests and holding back on any treatment. Although treatments improve and for most side effects are not what they were there is still the possibility that he could suffer some. If he is feeling well at the moment and is happy to accept the waiting for PSA results the simply getting on with life as it is seems like a fair option.

Dad seems to be in a middle of the road position so maybe just carry on carrying on until the team and Dad decide differently.

All the best

Kevan

User
Posted 27 Mar 2017 at 18:48

Unless your father has other health issues then it is more likely to be Active Surveillance.

It does seem a strange thing to be doing nothing about it when you know dad has been diagnosed with prostate cancer but it does allow a lot of breathing space.

My husband also went the AS route initially. His initial PSA was also around 5.7 with Gleason 3+4 contained. He eventually chose permanent seed brachytherapy when he was 73 because the PSA started to rise.

Download the Toolkit from our publications section, It is full of information and it may help your dad make a choise.

IT's good that you have joined a support group. Other peoples' stories can be very uplifting.

Welcome to the site by the way

We can't control the winds - but we can adjust our sails
User
Posted 28 Mar 2017 at 10:07

Hi,
there is a difference between 'watchful waiting' and 'active surveillance'. Watchful waiting was used in the old days to describe having a PSA test every so often and hoping it picked up any changes. Active surveillance (AS) is a more modern approach and if done properly is a good option for many men, especially those diagnosed with very low risk disease and those who are significantly older.
AS done properly involves regular PSA tests plus a DRE (finger up the bum) at least annually and annual scan. At 81, the hormone treatment can be debilitating and take away much of whatever energy he has left, it also wastes muscle and softens the ligaments so aches and pains can increase significantly. My dad is 80 this month and his cancer has recently come back (he first had it when he was 62) but because he dances, hikes and does a lot of gardening he has also opted to just monitor for now.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 16 Apr 2017 at 12:39
Thanks for the update.

I am sure that whatever you all decide to do will be right for you as I firmly believe that you feel a lot more confident if you are comfortable with the path you have chosen.

Kind regards for the future,

Kevan

Show Most Thanked Posts
User
Posted 27 Mar 2017 at 18:48

Unless your father has other health issues then it is more likely to be Active Surveillance.

It does seem a strange thing to be doing nothing about it when you know dad has been diagnosed with prostate cancer but it does allow a lot of breathing space.

My husband also went the AS route initially. His initial PSA was also around 5.7 with Gleason 3+4 contained. He eventually chose permanent seed brachytherapy when he was 73 because the PSA started to rise.

Download the Toolkit from our publications section, It is full of information and it may help your dad make a choise.

IT's good that you have joined a support group. Other peoples' stories can be very uplifting.

Welcome to the site by the way

We can't control the winds - but we can adjust our sails
User
Posted 28 Mar 2017 at 08:47
Hi

I can certainly spare some time for you and although not qualified to give advice I will happily give an opinion.

I think your team are right to advise monitoring through PSA tests and holding back on any treatment. Although treatments improve and for most side effects are not what they were there is still the possibility that he could suffer some. If he is feeling well at the moment and is happy to accept the waiting for PSA results the simply getting on with life as it is seems like a fair option.

Dad seems to be in a middle of the road position so maybe just carry on carrying on until the team and Dad decide differently.

All the best

Kevan

User
Posted 28 Mar 2017 at 10:07

Hi,
there is a difference between 'watchful waiting' and 'active surveillance'. Watchful waiting was used in the old days to describe having a PSA test every so often and hoping it picked up any changes. Active surveillance (AS) is a more modern approach and if done properly is a good option for many men, especially those diagnosed with very low risk disease and those who are significantly older.
AS done properly involves regular PSA tests plus a DRE (finger up the bum) at least annually and annual scan. At 81, the hormone treatment can be debilitating and take away much of whatever energy he has left, it also wastes muscle and softens the ligaments so aches and pains can increase significantly. My dad is 80 this month and his cancer has recently come back (he first had it when he was 62) but because he dances, hikes and does a lot of gardening he has also opted to just monitor for now.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 16 Apr 2017 at 11:03

Thank you all very much for your thoughts and and thoughtful quotes.

We have just established that the stage of the cancer within the prostate is T2C.

My Dad intends to discuss the treatment options with the team and make a discussion thereafter.

I'll post our progress here. 

User
Posted 16 Apr 2017 at 12:39
Thanks for the update.

I am sure that whatever you all decide to do will be right for you as I firmly believe that you feel a lot more confident if you are comfortable with the path you have chosen.

Kind regards for the future,

Kevan

User
Posted 17 Apr 2017 at 01:07
Hi Pete

Welcome

As you have asked for an opinion. . All things considered. Do as team suggest.

AS. See any PSA changes. As you now have a baseline and assuming no BPH or inflammation to effect reading then within 9 months you will have 3 readings. Cross a bridge as it arrives.. I'm assuming dad is continent. . So any treatment is likely to effect this . Again the degree is unknown.

AS should ensure he has a MRI at least annually. ..

It's ultimately down to dad's view of as you say dealing with it before progression from gland occurs. Do you attend his sessions with him ?

You could ask about position. Size of lesion and what the consultant recommends. Keep notes in my opinion.

Hope this helps a little. . All the best.

PS. May I ask .. Do you have regular PSA tests? ?

Gordon

Edited by member 17 Apr 2017 at 01:09  | Reason: Not specified

 
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