Is doing nothing an option ?

Hi,  A prostate of 96cc is very large and should generate a higher psa than normal.   There is a formula for size v psa somewhere but I can't find it.

Finasteride can cause depression it says on the NHS website.

It's easy to understand your concern if your psa is fluctuating although they haven't yet found anything cancerous.   Tomorrow you'll learn if it's more inflamed or something else.

If it's inflamed it's a trade off between risk of cancer and the risk you're willing to take.   It sounds like you're worrying about it and unless you can reduce your worrying you're going to keep having blood tests although you might increase the time between them.

One option is to pursue all options on treatment for inflammation and perhaps the doctor can advise more options,  even if it's not on the NHS.   I'm sorry I don't know the options and you might have already done it.

All the best, Peter

Edited by member 26 Oct 2022 at 22:18  | Reason: Not specified

Hi Grafton,  Your prostate is about 2.25inches diameter when it should be around 1.5inches at your age, assuming it's round.     The MRI will guide it although it's a bigger area to search overall.

I'm not exactly sure what watch and wait is but I'd at least want psa tests.  You know your prostate size to psa and it's rate of change.  If it suddenly changes at a faster rate it's better to know.

I am trying to clarify in my own mind whether 'opting out' of an investigation into the possibility of prostate cancer, at this point, is a valid alternative given that I am 75.

I have read that :

(i) Most localised prostate cancers are slow growing & may not need treatment or shorten a 'man's life.

(ii) Both Hormone Therapy & Radiotherapy come with their own risks & side effect, some of which may be significant.

(iii) That if prostate cancer does materialise it can be controlled, but not cured, using Hormone Therapy

The issue, for me, is really about how long, typically, does prostate cancer take to develop from the point at which I am perhaps now, to the time when it becomes potentially life changing. There was no sign of cancer in my 2020 biopsy - there may, or may not be, now. I am of the view that something is likely to 'get me' in the next 10 to 15 years & at this point I don't think that I would wish to go on longer. The last years of my parents lives were definitely not what they would have wished for & I hope never to find myself in their position.

I am not all 'gloomy' as a person but I definitely think too much !

Thanks again

I don't think your all gloomy, and I don't think you are thinking too much. You are thinking about the right amount for the situation you are in.

You have a reasonable idea of the timescales to expect from the rest of your life, and the speed cancer can progress.

I think the problem you have at the moment is, you haven't got a firm diagnosis, and based on past experience it will be a number of years before you have one.

Do you really want to be on the treadmill of tests looking for an illusive cancer, which will certainly be found one day if they keep looking hard enough (nearly all men your age have cancer, or will get it soon). Once it is found it may lie dormant for years, but they/you will probably want to treat it straight away.

I can give an example from my own experience with a much less serious disease, which I chose to ignore. I have one copy of the gene for hemochromatosis, in theory I should be fine but I have high iron (serum ferritin diagnosed at 450 normal range 30-300) for two years the hospital bled me every six months, the figure bobbed up and down. Then they failed to call me in, probably lost my records (another story). I ignored the problem for ten years, then with a PSA test I asked to check serum ferritin, it was high 500. GP wrote to hospital, who didn't respond, a year later I asked for another test it was 330, slightly above normal. I could have spent the last decade having pointless treatment if it wasn't for the good fortune of an incompetent hospital.

Rather than hedge my advice with caveats, I'll just tell you not to follow the advice of an idiot on the internet and then tell you what to do.

Ignore the disease until you are 80, maybe have annual PSA tests, but ignore the result if it is less than 30 (it's a big prostate, otherwise I'd have said 20). If the PSA gets above 30 or you get to 80 yo decide what to do then. Hopefully you'll get five worry free years, possibly then another five or ten. At anytime in between you might die, but that's the penalty of living a long life.

Lyn

Thanks for your comment. I suppose that this is an unlikely forum to raise the issue of foregoing the chance of treatment should it be necessary but is reassuring to learn of your, what must have been very sad, experience.

In another sense I feel a little guilty - your father-in-law must have led his life to the full  - I find it so easy to use age as an excuse for not doing something that I once enjoyed but now find a little more challenging. I must try & do better.

Grafton, on diagnosis at 62 my consultant said if we do nothing you will still be around in 10-15 years, that advice made me consider doing nothing even though I had cancer. 

I worked with a guy who had a fluctuating PSA that went over a 100 at times a trus and two guided template biopsies found nothing.

Good luck with your decision.

Thanks Chris 

I'm not suggesting that you do (or don't) get treatment; just that an "unmasked" PSA that's probably in the high 30s warrants proper investigation so you'll know where you stand and can make an informed decision. If your oncologist says "you have cancer but you'll probably live for another 15 years without treatment" then that would take you to 90 and statistically the odds are that something else will get you first. If, on the other hand, a biopsy shows a more aggressive cancer there would be a much stronger incentive to get treatment. 

Personally I didn't find my two years of treatment to be too bad. For most of it, when I was just on the HT, I felt fine. Tiredness and some weight gain were the main side-effects. For the first few weeks of HT I felt very "woolly headed" and couldn't think clearly, but that wore off after a couple of months. I had RT over a six week period. RT side-effects are cumulative. First 3-4 weeks were fine, but the last couple of weeks and the few weeks after we're mildly unpleasant with urinary and bowel issues. Urinary issues cleared up within a few weeks; bowels took longer - perhaps 3 months to get back to some form of stability and a year to return to normality. It didn't affect my life; I just took an Imodium tablet before I went out anywhere.

Hope that's of some help,

Chris