Treatment protocol for 85 year old dementia patient

User

Posted 10 Feb 2020 at 11:34

My father in law has just been diagnosed with prostate cancer. Diagnosis was by PSA (18) and prostate exam only, no biopsy or MRI. He has had a bone scan that was clear.

Treatment is to be ADT only no RT.

Question, can he have a diagnosis from a manual exam and PSA only? He has had a few minor urinary symptoms but no significant retention. I would have thought watchful waiting should have been an option too?

Thoughts please.

User

Posted 10 Feb 2020 at 13:34

Normally a biopsy is needed to diagnose PC. An MRI would also be a given, hopefully before the biopsy.

It might be the doctors have decided this is the best way to go but I would have expected some discussion to have taken place with your father in law with a family member present to agree this.

Ido4

User

Posted 10 Feb 2020 at 18:05

MRI's are not a big deal, and should be considered. But I would think hard before doing a Biopsy, as there are significant risks, especially for an 85 year old. I knew gentleman in his 80s who died of sepsis the day after a biopsy. (And the biopsy was negative).

If there is cancer, treatment is only worthwhile if the cancer would reduce your father-in-laws life expectancy. Life expectancy of an 85 year old male is 6 years, and most cancers would not reduce this. If there will be no treatment, irrespective of the result of a biopsy, then there is no point in a biopsy.

I would certainly veer away from any treatment which does not increase life expectancy. Then there is the question of quality of life. There are degrees of dementia. If I was 85 and suffering severe dementia, then I would not do any treatment that increased my life expectancy.

Best of luck with everything.

Edited by member 10 Feb 2020 at 18:11 | Reason: Not specified

User

Posted 10 Feb 2020 at 21:28

Certainly Dementia further complicates what is already a difficult decision for an 85 year old on whether to have radical treatment. Much depends on how how advanced his Dementia is and any other health problems. Is he able to understand his situation and say whether he wishes what might be life changing RT treatment if this could be obtained? Not doing anything must also be an option because even HT could further impact his quality of life. But passing away due to PCa can be a really bad way to go, so perhaps ADT might be a reasonable compromise. Has his GP proffered an opinion?

Barry

User

Posted 10 Feb 2020 at 23:02

GP only had the letter today. I guess my main concern is the ADT will make his dementia worse while not delivering any benefit in terms of symptom relief (he doesn't have any!)

User

Posted 04 Mar 2020 at 23:59

Ok so a few weeks, one HT injection and a course of casodex and he is now having random severe panick attacks. We think its associated with wanting the loo but not being able to pee, although things ultimately subside and all is ok.

Have pushed mother in law to go back to the urologist and to discuss the panick attacks with the dimentia consultant.

Any other ideas??

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