76 year old dad best course of action

70% of men aged 70 have prostate cancer, which they will die with, rather than of, it. Many are completely asymptomatic.

There is not really a ‘normal’ PSA range for the over seventies, and none for over eighties.

A PSA of 4.5 wouldn’t really be considered very ‘abnormal’ for a sixty year old, although the increase could be a concern.

I look after two old chaps, one, aged 86 with confirmed cancer he has had for five years, with a PSA of 300 odd originally, and who has hormone therapy, and is doing great, and my father-in-law, also 86, who is crippled with hip pain and who has urinary problems, yet his GP won’t even give him a PSA test, although he’s most likely got PCa too.

Tell your Dad to forego the biopsy, and go for the PSA test in six months. If he is that desperate to confirm that he has cancer, which I said at the start is most likely, he could have a non-invasive bone scan to see if there any signs of metastasis in his pelvis or elsewhere.

Others here will pitch in, I’m sure.

Best of luck.

Cheers, John.

Thank you for the responses.

Having done some more reading I am somewhat concerned that by leaving the PSA for another 6 months we could miss something. It looks like a PSA cannot be too reliable as some with 4 could have aggressive cancer and some with 40 none at all! 

i understand it’s a slow grower but given his fathers history would you still say a biopsy would be a bad idea? If it’s something aggressive then 6 months could be too long to wait surely...

Dolly, it's not the PSA value that matters as much as the trend. If he has 3-monthly PSA tests and each test shows an increase over the one before, that would be a cause for concern.

Does he have prostate cancer? He probably does - three quarters of men his age do. Getting prostate cancer is essentially a matter of being a man and living long enough. Does it need treatment? Probably not, unless tests indicate otherwise. Most men his age die with prostate cancer, not from it.

Prostate cancer is not a death sentence unless it spreads outside the prostate, and with a PSA of 4.5 his is vanishingly unlikely to have done so unless it's some rare and exotic variety.

Try not to worry.

Best wishes,

Chris

Edited by member 27 Nov 2020 at 13:35  | Reason: Not specified

Thank you all.

the doctor has said they want to do a biopsy first which will be MRI guided, and an MRI afterwards if necessary. 

Biopsy is booked in for the 17th with a 10 day course of two different antibiotics to begin the morning of the biopsy. 

Does this sound like the correct process? 

He requested a repeat PSA yesterday which came back at 5.26 up from the 4.5 a week or so ago which terrifies me as it makes me feel as though two weeks for a biopsy is too long as it’ll be another two weeks after that for any results. 

Still completely asymptomatic. 

Thanks for the response.

I really don’t know how to approach this now, as I’ve already asked for him to enquire with the doctor but the doctor has told him there is no need for an MRI at this stage and want to proceed with the biopsy first. 

I’m scared they are failing him. 

Thank you. 

I don’t think they’re concerned about Covid to be honest, protocol at the hospital require a Covid test prior to any procedures or admissions. Of course, Covid is another worry of mine as he is vulnerable. 

It’s quite bizarre as looking and speaking to him he seems perfectly healthy. So, I hope, if it is indeed cancer then this has been caught early. 

I am concerned about the risk of infection with the biopsy but I hope they know what they’re doing and the antibiotics do the job. Initially it did feel as though this type of biopsy was quite archaic but looking online it seems very common. 

I wish I could be there with him but I’d need to isolate myself from him with a small baby for two weeks, I couldn’t risk carrying Covid there. I will have to wait and see what the biopsy results are and take it from there. 

They have said he will be staying in the hospital after the biopsy for a couple of hours and will then be free to leave. Does anyone know how the recovery is and if he is likely to need help round the house etc?

Good heavens, no! John had his biopsy on the way to work. He may have blood in his urine for a short time afterwards and / or in his sperm for anything from a few days to a few weeks (depends how often he ejaculates) but other than that, he shouldn't have any side effects at all

I was diagnosed nearly 7 years ago. I had the Ultrasound guided 12 sample Trus biopsy and MRI after the biopsy. It may not be the gold standard treatment of today, it worked for me, but a better scan and biopsy may have changed the treatment. I had the biopsy one afternoon and was back at work the next day. 

I didn't want to have conversations with my family during the diagnosis process, I went on my own to all the appointments. I am not saying it was the right thing to do, don't push him into a corner.

Added, it is great that he has a daughter who cares so much about him.

Thanks Chris

Edited by member 03 Dec 2020 at 08:37  | Reason: Not specified

I think perhaps you are reading / researching too much - this is your dad's issue and it is his right to decide how he wants to progress and how much trust he has in his medics. 

Also, bear in mind that 70% of men in their 70s and 80% of men in their 80s have some prostate cancer. Most die with it, not of it, and most are asymptomatic.

My mate is 86, has had PCa for five years, and he takes HT tablets. His cancer has not really affected him, except there is some spread to his hip and pelvis and now he walks with a limp.

If he were my dad, I wouldn’t be overly concerned, considering his overall good health and his low PSA. Depending on the results of the biopsy, he might only end up on active surveillance or hormone therapy tablets or implants.

Best of luck.

Cheers, John.

That’s great news!

Bloody good service in Cyprus.

Cheers, John.

So we have an update. My dad collected the MRI report today and the doctor explained to him that there is a very small suspicious area on the inside wall of the prostate, he said it could be scarring from prostatitis but they don’t know so it’s worth investigating with the biopsy tomorrow. 

The report itself states the area is PI-RADS 3.

Looking over the report, they seem to have identified several areas that they noted on however all were scored as PI-RADS 1 & 2 apart from this area. 

TRUS biopsy (guided) is tomorrow morning. 

I’m assuming a biopsy is definitely the right thing to do now?

Thanks for the reply. Hope you are well!

Well, it’s done. And now, we wait..

Have a nice Christmas everyone. 

Well, dad received an unexpected call from the Urologist today! We were told it would be a two week wait for results for the TRUS biopsy. 

All clear. He said there was nothing in any of the samples (I believe 20 were taken) including the suspicious area shown on the MRI. They took samples from both sides. The report states nodular hyperplasia and mild prostatitis. 

He has said they will repeat PSA in 12 months but dad is going to do that in 6. 

I am hoping that since the MRI was performed beforehand; there is little chance these results are false negatives and the rise in PSA is due to the prostatitis. 

Great news but very bizarre given his age and family history. Still, I’ll take it! 

On a side note, does anyone know what p40 is? The lab report says p40 positive, AMARCK negative. Can’t find much online as to what that actually means 

Edited by member 21 Dec 2020 at 21:02  | Reason: Not specified