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RARP at Age 75 - decisions!

User
Posted 06 Jul 2021 at 13:30

Hello All,

What a wonderful support group!

I am posting some questions on behalf of a friend who recently had a Prostate Cancer diagnosis.

I hope some members may be able to share their experience.

1. Have any members had a Robotic Assisted Radical Prostatectomy at Age 75 or older? This has been offered.

2. Did you have weigh up competing treatment options i.e. between Radiation and Surgery?

3. Why did you pick surgery and were there any age related surgical concerns discussed with surgeon if opting for surgery?

4. Were side affects like incontinence as expected (or worse given age) and did continence recover back to normal levels?

 

My friend's diagnosis was:

-Cancer in both lobes of prostate

-Perineural Invasion seen

-Gleason score of 3+4 after Transperineal Fusion Biopsy

-13/32 cores with adenocarcinoma

-PSA of 2.5

-No evidence of definite extracapsular extension or spread to lymph nodes or bones based on 3T-MRI imaging

-Staging: T2,N0,MX

Otherwise he is a healthy 75 with no underlying conditions. All options of treatment open to him, hence the questions!

 

Thank you for your support any responses which I will share with him and hopefully alleviate any anxiety!

Edited by member 07 Jul 2021 at 10:53  | Reason: update to text as forgotten to include a couple of key points

User
Posted 07 Jul 2021 at 07:15

75 seems quite old for surgery. I had mine at 68 last year and haven't seen anyone older since I've been on these boards. From what I can see my results haven't been too far different from younger people - a bit better than average on continence and somewhat worse on ED, but I only had nerve-sparing one side, so that was to be expected.

I recovered fine from the surgery; from what I can see it took around the same time for me as all the guys in their late 50s and better than some in their 60s. That can often be more affected by general health (things such as being overweight and smoking affect recovery) than age.

As I have understood it from other's experiences, surgery is not often offered to older men, not just because the surgery risks can be higher (I presume they don't see you friend as at risk), but because at 75 something else is likely to kill you before PCa, so they prefer less invasive treatment. However, I read a Canadian study that said surgery was OK for people up to at least 75.

It wasn't suitable for me, but if I was your friend I would look at whether Brachytherapy was suitable.

Another point. I spotted the words "perineural invasion". That suggests that the cancer has spread beyond the prostate. If so, it puzzles me that surgery is an option, but I'm a mere whippersnapper on these boards.

P.S. that seems a very low PSA for a 3+4, with 13/32 cores.

User
Posted 07 Jul 2021 at 08:25
I know that men over 75 are not ruled out of surgery in our area simply due to their age. If youd friend has been told surgery is not being offered it is more likely to be due to the perineural invasion and volume of cancer. It may be that they could only do non-nerve sparing surgery or that it is already known that he would still need adjuvant radiotherapy, in which case there is little point putting a 75 year old through two lots of side effects
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 07 Jul 2021 at 10:35
My father-in-law has just had very successful hip replacement surgery aged 86, but if I were you (or your friend) I would be seeing an oncologist rather than a surgeon.

Best of luck.

Cheers, John.

User
Posted 07 Jul 2021 at 10:55
Thank you all for your input and some reassuring experiences, I will pass them on.

I should add that he has been offered RARP at age 75.

I have updated my original post to reflect this.

User
Posted 07 Jul 2021 at 12:23
RT of one form or another would also be my choice at 75 with the given diagnosis, assuming this was not ruled out for any reason.

It's interesting that PSA was only 2.5 an is not commonly found to be so low but goes to show that as a diagnostic test PSA of itself is not a good one.

Barry
 
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