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My old Father

User
Posted 23 Aug 2021 at 08:02

My 93 old Father was referred to Urology pronto with a "blood test", presumably psa, of 26. No DRE. No urinary symptoms.

My Father attended Urology on his own, and, according to his report, the Urologist said:

"Why have you been referred to me?"

"Who referred you?"

"I don't know why you've been  referred to me?"

"We don't like doing blood tests on old people."

My Dad asked "Are you telling me that I've got cancer?"

"No I can't tell you you've got cancer."

Also: "Everyone over eighty has cancer."

 

My Dad explained that I have PCa (as does his brother):

"Well you must know all about it then."

 

No further action. It was left that the Urologist would write to his - seemingly miscreant, GP.

I am not too happy at the way a 93 year old patient, albeit fit capable and in generally good health, was treated.

I appreciate that - most unfortunately, PSA screening is not recommended by NICE etc.
Is it true that they just don't want to investigate elderly men with elevated PSA but no presenting symptoms?

I don't much like how a man of his age on his own was handled either.

 

User
Posted 23 Aug 2021 at 20:15

Since it is generally considered that all men of 80 & over have prostate cancer ( 1 in 5 men aged 40 have it and most men over 60), the Urologist was correct in what he said. His manner, if that is exactly what took place, was not, shall we say, patient friendly, and was obviously upsetting for your father. A PSA reading of 26 is not out of the ordinary for a man of your fathers age and at his age there is very little medically that can be done for his prostate cancer. That said, if your father is not experiencing any urinary symptoms  and has not had an MRI scan or biopsy (which would probably be unwise at your fathers age) then there is no real evidence that he does indeed have the cancer. Any treatment for the cancer if he did have it would, because of his age, probably be worse than the cancer itself.

User
Posted 23 Aug 2021 at 20:41

Why was he on his own at the appointment?

The medical decision making seems reasonable - as ohdear says, the treatment would probably remove whatever quality of life your dad currently enjoys. If you want to complain about the way he was spoken to, perhaps contact PALS first?

Edited by member 24 Aug 2021 at 10:44  | Reason: Not specified

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

User
Posted 23 Aug 2021 at 22:06

Dad had been referred and it was quite disgraceful to treat him in this way. This experience may well deter him from seeking medical advice/treatment for any problen in future. I would also report the experience to PALS.. It seems Dad is suffering from his situation and is entitled to have some treatment to alleviate his situation even if this does not include radical treatment which might cause other problems. If his condition didn't merit exploration, his GP wouldn't have referred him.

What is your source for suggesting that a PSA of 26 is not out of the ordinary for a man in his nineties Oh Dear?

'Conclusion:
Our findings suggest that the prevalence of clinically significant prostate cancer in the elderly population may be higher than previously thought. As the population continues to live longer and healthier lives, it will become more common to confront prostate cancer morbidity in the eldery population. Using higher serum PSA thresholds to eliminate unnecessary biopsies in older men does not appear to help identify patients at greater risk of having clinically significant prostate cancer. Patients with prostate cancer having aggressive clinical features may benefit from treatment of their prostate cancer well into their eighth and ninth decades of life. Testing and diagnostic recommendations should reflect the potential benefit of identifying patients with aggressive prostate cancer even after age 75.' From https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2692165/

 

 

Edited by member 23 Aug 2021 at 22:11  | Reason: to highlight link

Barry
User
Posted 24 Aug 2021 at 00:55

I have some sympathy with the urologist. What can he do to improve your dad's quality of life? Well perhaps be a bit more civil in his communication skills, but I doubt he can cure his cancer, so it is pointless testing for it. 

Dave

User
Posted 24 Aug 2021 at 07:43

Morning Old Barry

 

During my biopsy and the conversation I had whilst undergoing it, I was told by the surgeon that the general view was that there was no point  just testing PSA levels for cancer for men over 80 as the levels would always be high  (he mentioned well over 20) and that unless quality of life was being affected it was best to leave alone.

 

Ivan

User
Posted 24 Aug 2021 at 12:38

In reply to OhDear I would say that sometimes consultants use hyperbole to make a point. I can find nothing to support the contention that it is nothing out of the ordinary for a man to have a PSA of 26 in his nineties. On my regular PSA results age specific ranges where referral should be made excepting confounding factors such as UTI are:- 40-49years 0-2.5 ug/L
50-59 " 0-3.5 "
60-69 " 0-4.5 "
70+ " 0-6.5 "
So although the PSA range escalates with increasing age, it's not dramatically so.

As regards the reported response of Dad's consultant, we could only go on what was said and not the way it was delivered. It is well known that many elderly men just accept what they are told and don't complain about the way they are talked to. Often they are very reluctant to seek medical help in the first place so may well be deterred from going to a doctor in future if spoken to like Dad was.

We don't know what can be done to alleviate Dad's condition until he is properly assessed.

It is the case that there can come a point when late in life some forms of treatment may be counter productive in terms of quality of life but this should be carefully explained and men given options which I fear it not always the case.

I will be 85 next week DV and having my second HIFU because I think this is a better option for me than having HT, although this is probably my last chance of a more radical treatment before having to rely on HT. My father had his Prostate treatment at about my age and lived to 97 or 98, dying due to complications of a fall, not PCa. I hope to emulate him in this respect as I am a carer for my wife. I strongly agree with the 'Conclusion' extracted from the link I gave in my previous post.

 

 

 

 

 

 

 

 

 

 

 

Edited by member 24 Aug 2021 at 12:42  | Reason: Not specified

Barry
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User
Posted 23 Aug 2021 at 20:15

Since it is generally considered that all men of 80 & over have prostate cancer ( 1 in 5 men aged 40 have it and most men over 60), the Urologist was correct in what he said. His manner, if that is exactly what took place, was not, shall we say, patient friendly, and was obviously upsetting for your father. A PSA reading of 26 is not out of the ordinary for a man of your fathers age and at his age there is very little medically that can be done for his prostate cancer. That said, if your father is not experiencing any urinary symptoms  and has not had an MRI scan or biopsy (which would probably be unwise at your fathers age) then there is no real evidence that he does indeed have the cancer. Any treatment for the cancer if he did have it would, because of his age, probably be worse than the cancer itself.

User
Posted 23 Aug 2021 at 20:41

Why was he on his own at the appointment?

The medical decision making seems reasonable - as ohdear says, the treatment would probably remove whatever quality of life your dad currently enjoys. If you want to complain about the way he was spoken to, perhaps contact PALS first?

Edited by member 24 Aug 2021 at 10:44  | Reason: Not specified

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

User
Posted 23 Aug 2021 at 22:06

Dad had been referred and it was quite disgraceful to treat him in this way. This experience may well deter him from seeking medical advice/treatment for any problen in future. I would also report the experience to PALS.. It seems Dad is suffering from his situation and is entitled to have some treatment to alleviate his situation even if this does not include radical treatment which might cause other problems. If his condition didn't merit exploration, his GP wouldn't have referred him.

What is your source for suggesting that a PSA of 26 is not out of the ordinary for a man in his nineties Oh Dear?

'Conclusion:
Our findings suggest that the prevalence of clinically significant prostate cancer in the elderly population may be higher than previously thought. As the population continues to live longer and healthier lives, it will become more common to confront prostate cancer morbidity in the eldery population. Using higher serum PSA thresholds to eliminate unnecessary biopsies in older men does not appear to help identify patients at greater risk of having clinically significant prostate cancer. Patients with prostate cancer having aggressive clinical features may benefit from treatment of their prostate cancer well into their eighth and ninth decades of life. Testing and diagnostic recommendations should reflect the potential benefit of identifying patients with aggressive prostate cancer even after age 75.' From https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2692165/

 

 

Edited by member 23 Aug 2021 at 22:11  | Reason: to highlight link

Barry
User
Posted 24 Aug 2021 at 00:55

I have some sympathy with the urologist. What can he do to improve your dad's quality of life? Well perhaps be a bit more civil in his communication skills, but I doubt he can cure his cancer, so it is pointless testing for it. 

Dave

User
Posted 24 Aug 2021 at 07:43

Morning Old Barry

 

During my biopsy and the conversation I had whilst undergoing it, I was told by the surgeon that the general view was that there was no point  just testing PSA levels for cancer for men over 80 as the levels would always be high  (he mentioned well over 20) and that unless quality of life was being affected it was best to leave alone.

 

Ivan

User
Posted 24 Aug 2021 at 08:09

Thank you all very much for your replies. They are reassuring, and that's helpful. It's all very well knowing stuff, but perspective changes when it's your own father; plus  I know too well the evils of this disease.

He is very physically fit, able and mentally competent. He is independent, he helps others, he drives and he leads a very busy life in the church. He is fitter than most twenty years younger! There's no reason that he'd require support to visit a doctor normally. However, it is true that, in this instance, he was unaware of the potential nature of this referral. 

I did explain to him that the disease, like cataracts, comes with age, and that only biopsy can diagnose it; that both biopsy and treatment are intrusive and harmful and that PCa is likely the most over-treated condition. I advised him to await the Urologist letter - which hopefully he will receive a copy of, but then to discuss with his GP. I offered to talk to his GP, but I doubt he'll accept that offer.

I have no desire whatsoever to complain. I asked Dad if the Urologist was some stereo-typical arrogant surgeon type, but he said "No not really". I don't think he even disliked the chap, but did find his responses rather bewildering.

User
Posted 24 Aug 2021 at 12:38

In reply to OhDear I would say that sometimes consultants use hyperbole to make a point. I can find nothing to support the contention that it is nothing out of the ordinary for a man to have a PSA of 26 in his nineties. On my regular PSA results age specific ranges where referral should be made excepting confounding factors such as UTI are:- 40-49years 0-2.5 ug/L
50-59 " 0-3.5 "
60-69 " 0-4.5 "
70+ " 0-6.5 "
So although the PSA range escalates with increasing age, it's not dramatically so.

As regards the reported response of Dad's consultant, we could only go on what was said and not the way it was delivered. It is well known that many elderly men just accept what they are told and don't complain about the way they are talked to. Often they are very reluctant to seek medical help in the first place so may well be deterred from going to a doctor in future if spoken to like Dad was.

We don't know what can be done to alleviate Dad's condition until he is properly assessed.

It is the case that there can come a point when late in life some forms of treatment may be counter productive in terms of quality of life but this should be carefully explained and men given options which I fear it not always the case.

I will be 85 next week DV and having my second HIFU because I think this is a better option for me than having HT, although this is probably my last chance of a more radical treatment before having to rely on HT. My father had his Prostate treatment at about my age and lived to 97 or 98, dying due to complications of a fall, not PCa. I hope to emulate him in this respect as I am a carer for my wife. I strongly agree with the 'Conclusion' extracted from the link I gave in my previous post.

 

 

 

 

 

 

 

 

 

 

 

Edited by member 24 Aug 2021 at 12:42  | Reason: Not specified

Barry
User
Posted 31 Aug 2021 at 17:42

I advised him to  insist on psa tests 6 monthly, or later maybe 12 monthly.

 
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