I'm interested in conversations about and I want to talk about
Know exactly what you want?
Show search

Notification

Error

76 year old dad best course of action

User
Posted 26 Nov 2020 at 20:17

Hi All. I'm posting this because I'm concerned about my 76 year old father.

 

His annual routine blood work has all come back ok apart from his PSA which although apparently still in range at 4.5 is an increase from last years 2.6

 

His father died from undiagnosed Prostate cancer around this age.

 

He has no symptoms at all and has been to the urologist who did a physical examination and said his Prostate is not enlarged. He advised he was not concerned it would be anything too sinister with a level of 4.5 however they could wait 6 months and do a repeat PSA or do a biopsy in a week or so.

 

My dad has chosen to go for a biopsy but I've read this can be quite painful and can also miss cancer. I've read an MRI could be a better first option as many have unnecessary biopsies and I'm scared about sepsis
 

He's not UK based and this will be done with the private healthcare. 
 

Any advice would be appreciated.

User
Posted 03 Dec 2020 at 08:38

Thanks Chris, that’s encouraging when the net is full of horror stories! 

User
Posted 26 Nov 2020 at 20:17

Hi All. I'm posting this because I'm concerned about my 76 year old father.

 

His annual routine blood work has all come back ok apart from his PSA which although apparently still in range at 4.5 is an increase from last years 2.6

 

His father died from undiagnosed Prostate cancer around this age.

 

He has no symptoms at all and has been to the urologist who did a physical examination and said his Prostate is not enlarged. He advised he was not concerned it would be anything too sinister with a level of 4.5 however they could wait 6 months and do a repeat PSA or do a biopsy in a week or so.

 

My dad has chosen to go for a biopsy but I've read this can be quite painful and can also miss cancer. I've read an MRI could be a better first option as many have unnecessary biopsies and I'm scared about sepsis
 

He's not UK based and this will be done with the private healthcare. 
 

Any advice would be appreciated.

Show Most Thanked Posts
User
Posted 26 Nov 2020 at 23:48

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.

User
Posted 26 Nov 2020 at 23:57
My father-in-law was diagnosed at the age of 79 and wished he hadn't - it was just part of a well man check. He decided against any treatment because he felt it would have affected his quality of life too much.

I suppose the question to ask your dad is, if he was diagnosed, would he have radical treatment with all the possible side effects or would he want to carry on with life as it is now.

Personally, if it was my dad I would be encouraging him to wait 6 months and then if the PSA has risen again, push for an MRI scan before biopsy.

Prostate biopsy isn't excessively painful - it is most often described as like being flicked with an elastic band or having an injection at the dentist - that is assuming that he is having a basic biopsy taken from up his bum. Sepsis is extremely rare and not your biggest issue here. What you might perhaps be more concerned about is that there are better & more reliable types of biopsy - perhaps post covid, he will have the option of a template biopsy if the pSA has risen again.

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

User
Posted 27 Nov 2020 at 09:24

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...

User
Posted 27 Nov 2020 at 13:05
It could be 100 and not be cancer. PSA is not reliable on its own but the urologist has also done a DRE and found a soft prostate of normal size - it is probably the combination of PSA in normal range / normal DRE / no symptoms that is leading the urologist to recommend waiting 6 months.

If dad wants a biopsy then at least encourage him to pay for an MRI scan first - otherwise, the biopsy is like sticking a needle in a fruit cake and hoping to spear a cherry. If they scan first, they can then target the biopsy to any areas that look a bit suspect. Alternatively, he could ask whether template biopsies are available in his country but a template biopsy may need a general anaesthetic and some countries won't have the facilities or are not doing them at the minute because of Covid.

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

User
Posted 27 Nov 2020 at 13:34

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

User
Posted 27 Nov 2020 at 13:40

In the circumstances, I would have another PSA test in 3 months. I would then have an MRI if there is a significant rise in PSA. Unless the MRI is done first, suggesting any suspicious area or because a DRE (Digital Rear Examination) has not suggested a suspicious area either, taking a nominal number of biopsy cores with a TRUS biopsy would be like sticking say 12 needles into a plum expecting to hit any cancer. Certainly there would be more chance of finding this with a Template biopsy taking many cores, but this is a theatre procedure most usually done under anaesthesia. If there is a strong reason to suspect there is cancer but no suspicious areas can be seen on MRI to direct needles, this might be an option, if no other reason can be found to explain further increase in PSA.

Edited by member 28 Nov 2020 at 01:39  | Reason: for clarity

Barry
User
Posted 02 Dec 2020 at 11:13

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. 

User
Posted 02 Dec 2020 at 12:39

The best practice is to have an MP-MRI scan at the highest possible resolution (1.5 Tesla, 3 Tesla is better, be prepared to travel for 3T High Definition) in advance of any invasive biopsy (transperineal, preferably, rather than TRUS).

The fact that they are recommending umpteen antibiotics in advance of a biopsy, makes me think that it will be a TRUS rectal procedure, piercing the bowel in multiple places, with its inherent risk of infection.

If you are paying for this I would imagine you have some control over what is spent, so invest in an MRI scan and a radiologist’s report first, BEFORE any biopsy.

What country are you in?

Best of luck to your Dad.

Cheers, John.

Edited by member 02 Dec 2020 at 12:48  | Reason: Not specified

User
Posted 02 Dec 2020 at 12:49

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. 

User
Posted 02 Dec 2020 at 20:05

They aren't failing him; they are following the same procedures that most countries have. It may be that the risk (from Covid) of taking him in for a template biopsy is greater than the risk of an infection with a TRUS biopsy, plus a lot of hospitals don't have the operating theatres available for template biopsies right now (due to Covid). An image guided biopsy is much better than the old biopsies anyway.

If his PSA has risen by more than 15% just in that short time, he is more likely to have an infection than cancer. Prostate cancer just does not make PSA rise that dramatically. Of course, he might have prostate cancer AND an infection.

Hard but try to relax a bit and trust the doctors - generally speaking, they are experts in their field and also - currently - well aware of how best to manage the potential cancer v the risk of covid.

Edited by member 02 Dec 2020 at 20:06  | Reason: Not specified

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

User
Posted 02 Dec 2020 at 20:47

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?

 

User
Posted 02 Dec 2020 at 21:56
Recovery is no big deal. He’ll feel a bit bruised and be peeing blood for a few days, but that’s pretty much it for the overwhelming majority of men. He certainly won’t need any help doing anything. After the biopsy they feed you gallons of tea and wait for you to pee in a bottle - that’s the reason for having to wait a couple of hours. Very rarely the poor bruised prostate can swell up and prevent you from peeing, in which case they fit a catheter, but this is not at all common.

Anticipation of the biopsy is far worse than the actual event. He’ll be fine.

Best wishes,

Chris

User
Posted 03 Dec 2020 at 00:34

Originally Posted by: Online Community Member
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

 

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

User
Posted 03 Dec 2020 at 08:13

Thanks all. There is a different hospital with this Tesla 3 equipment mentioned above that do prostate MRI, I have tried asking my dad to get a second opinion from there however he spoke to his general practitioner before I spoke to him for his “second opinion” (he is telling me he spoke to a 2nd specialist but my brother has told me it was his GP) and she agreed with the biopsy so he has just shut down, says he has made up his mind about the 12 needle biopsy and will have an MRI afterwards. He doesn’t want to talk about it anymore. I think he feels I am being neurotic by looking into other options. 

I am tempted to speak to the other hospital myself and see what they have to say about it. I’m also somewhat frustrated they agreed with another PSA only a week after his digital exam as I have read it not only can fluctuate too much for an accurate result in a week but the exam can affect it too. 

Edited by member 03 Dec 2020 at 08:15  | Reason: Not specified

User
Posted 03 Dec 2020 at 08:25

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

User
Posted 03 Dec 2020 at 08:38

Thanks Chris, that’s encouraging when the net is full of horror stories! 

User
Posted 03 Dec 2020 at 10:48

Originally Posted by: Online Community Member
I am tempted to speak to the other hospital myself and see what they have to say about it. I’m also somewhat frustrated they agreed with another PSA only a week after his digital exam as I have read it not only can fluctuate too much for an accurate result in a week but the exam can affect it too.

 

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. 

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

User
Posted 03 Dec 2020 at 11:17

Perhaps, but had I not done so we’d have no idea there were other (possibly safer) biopsy options or even MRI’s that could be beneficial. The doctor didn’t give him any options, simply prescribed the antibiotics and gave him a biopsy date. I’m not happy with that especially having read about the care many receive in the UK. 

User
Posted 03 Dec 2020 at 13:59
You still haven’t said what part of the world you are in...

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.

User
Posted 03 Dec 2020 at 14:25

Sorry, he’s in Cyprus. 

I agree with you however due to his fathers history with this he wants to be safe. 

He saw his urologist today who has happily referred him for an MRI tomorrow. 

 

User
Posted 03 Dec 2020 at 17:16

Originally Posted by: Online Community Member

Sorry, he’s in Cyprus. 

I agree with you however due to his fathers history with this he wants to be safe. 

He saw his urologist today who has happily referred him for an MRI tomorrow. 

That’s great news!

Bloody good service in Cyprus.

Cheers, John.

User
Posted 14 Dec 2020 at 15:44

Just an update. 

Dad doesn’t have the MRI report yet but with the biopsy looming in two days time, the urologist met with the radiologist/team about the MRI and they have agreed there is “something suspicious” on the left side of the prostate. 

Without the report, I have no idea how serious this can be but hoping since it doesn’t appear to be glaringly obvious to the team and is only on one side, this is something we’ll be able to get through. 

User
Posted 14 Dec 2020 at 18:44
Patients don't normally receive a copy of the MRI report, especially before the biopsy and any full diagnosis is made. Perhaps it is different in Cyprus?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 14 Dec 2020 at 19:07

It was done privately, not on their national health service. He was told he’d receive a copy when it was ready. The urologist met with them to get an overview as he needed to know whether he was going to proceed with the biopsy. 

I’m extremely nervous about the risk of infection. Being 77 now, I’m not sure how his body would handle it. 

User
Posted 16 Dec 2020 at 17:49

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?

User
Posted 16 Dec 2020 at 22:46
Yes, definitely the right thing to do.

Chris

User
Posted 17 Dec 2020 at 10:34

Thanks for the reply. Hope you are well!

 

Well, it’s done. And now, we wait..

 

Have a nice Christmas everyone. 

User
Posted 17 Dec 2020 at 15:45
Great! Put it out of your mind and enjoy Christmas. I'm sure your Dad isn't stressing about it as much as you are 😁.

Best wishes,

Chris

User
Posted 21 Dec 2020 at 14:42

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

User
Posted 22 Dec 2020 at 10:07

That’s really good news. I don’t know what p40 is, hopefully someone does!

Ido4

User
Posted 22 Dec 2020 at 11:13
P40 is an antibody but whether positive is a good thing or a bad thing may depend on the country where the report is being produced. I suspect that these two details are specific to Cyprus.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 22 Dec 2020 at 17:42

Thanks!

Have a nice Christmas & new year all. 

 
Forum Jump  
©2021 Prostate Cancer UK