Big decisions

Hi

It is sensible to take stock of where the tests may lead to and whetheryou want to go there or let nature take it's course. Even untreated PCa generally being a slow progressing disease may mean that it never becomes a problem for you, although if it does it can be a rotten way to die. So the first thing you have to consider is your lfe expectancy and did you father or close relative die of PCa. Then you have to factor in your health and any other health problems that might affect your life expectancy. Then you have to consider potential side effects and down sides of treatment and how risk adverse you are.

From a medical aspect you don't know your position until you have had your biopsy and perhaps a bone scan. When all tests have been completed you have a better idea of where you stand and what treatment you will be offered and could make your decision on proceding at that time. I would hold out for the transperineal biopsy as apart from being more accurate it results in much reduced risk of infection than the TRUS one. If your cancer is thought to be contained within the Prostate, you may be offered RT with or without HT and less likely but possibly surgery. If it is decided that your cancer is beyond where RT could be effective or possible, you would likely be offered a systemic treatment, probably HT, at least initially and maybe long term if it is working well enough to constrain you cancer. Unfortunately, you don't know as an individual how well you will respond to treatment or to the extent that you will be affected by side effects. Some useful information is provided here but some generalizations have to be made. Fewer men have surgery at your age and for those that have RT frequency and urgency usually reduce to pretreatment levels a couple of months or so after RT. Provided a man encourages them to happen erections can continue for quite some time although if HT is given inclination can diminish and is likely to diminish in a few years time anyway.

https://shop.prostatecanceruk.org//our-publications/all-publications/tool-kit?limit=100

Edited by member 19 Oct 2021 at 16:04  | Reason: to highlight link

There are situations where an older patient may be diagnosed and treated on the strength of their scans alone but in your case this could be risky, particularly if it turns out that you have a low secreting prostate cancer. Low secreting prostate cancer (normal PSA readings) can be much more aggressive / more likely to metastasise and the PSA can't be relied on to monitor what is happening.

If you are diagnosed, no one is going to force you to have treatment. My father-in-law was diagnosed at 79 and decided against any treatment that could affect his sex life so active surveillance was agreed. Unfortunately, in his case, that wasn't done correctly by the hospital and they failed to factor in that his PSA was not behaving normally - by the time he died, 4 years later, the cancer had spread to soft organs without anyone realising. If you are diagnosed and you go for active surveillance, just make sure that you get an MRI scan and digital rectal examination at least annually.