Treatment Required for PSA of 30?

Is he under a urologist or is it an oncologist?

At 82, it may be that your dad is reluctant to have treatment that can have unpleasant side effects or that the oncologist feels he isn't fit enough for.

When did he last have an MRI scan?

Thanks for the quick response all.

Yes he has had MRI/Biopsy several years ago to confirm the diagnosis (Gleason 3+4 back then) and he did have a radio pellet inserted to shrink it (about 4-5 years ago).

Hes been trying to contact the Urologist as he has had a pain in his groin (which they told him to contact them if it happens), but has been unable to get through.
Hes reverted to seeing his GP for this (who say they dont think it is prostate related luckily), but they are sending him for an x-Ray to review

I understand at his age there may not be a lot of actual treatment options, and dad may know a bit more than hes letting on.

Saying that though, he was pretty stressed when they told him to wait until PCA40 ... his words were along the lines of... they told me that when it hit 20 they would intervene and said same thing again when it hit 30 (Radiation for 5 days for 5-7 weeks), now they are saying to just wait again until its 40..  

So I dont think he had a discussion about an actual prognosis and 'No treatment' options. 

We are pretty resigned to the prognosis likely being there isnt much that can be done, but would be better for that to be clear. 

I know each case is different, but would it be normal for some sort of intervention to have happened by the time of PCA30? 

Unfortunately, arranging to actually speak to the consultant is the hard part in current climate 

Hi again,

Firstly, if Dad cannot get through to his Consultant directly, he could ask the Hospital to put him through to his/her Secretary with a view to getting an appointment. It doesn't sound like he has been allocated a specialist nurse because if he had, s/he should be able to assist if contacted.

It may well be that due to age and other problems, a Prostatectomy would be ruled out but most men are able to have RT and tolerate it well. It is usually given in conjunction with HT (Hormone Therapy). In advanced cases, which Dad's may well not be, HT and chemo might be options. HT does seem to produce more side effects in men than RT. The staging represents how advanced the PCa is and this usually determines, along with other individual contraindications, what treatment might be ruled out. We don't know this in Dad's case and it may be a factor in determining the way forward here.

You are right that most men with a PSA of 30 and a Gleason of 3+4 would expect to have some form of treatment other than when there are reasons why an individual is unsuitable or doesn't wish to have it.

Edited by member 10 May 2023 at 13:22  | Reason: Not specified

Okay, there is some misunderstanding or lack of clarity here I think. A radio pellet to shrink the prostate doesn't exist - it seems your dad had brachytherapy which is a form of radiotherapy used to treat prostate cancer by inserting radioactive seeds into the prostate. Once a man has had brachytherapy, he can't have any more radiotherapy of any kind in or around his pelvis, and cannot have the prostate removed surgically. This means there is no other curative treatment they can offer your dad and the only thing he can do is to have hormone tablets or hormone injections to slow the growth of the cancer down. 

It might be that he is already taking hormone tablets or having an injection every 3 or 6 months without realising that this is for his prostate cancer - do you know whether that is possible? If that's the case, the doctors may be delaying doing anything else because they don't think he is fit enough to have chemotherapy. Chemo doesn't kill prostate cancer, all it can do is slow it down and obviously, it can have some pretty awful side effects for an old man. 

If he is definitely not already having hormone treatment, then yes, this is what would normally be offered. But hormone treatment doesn't last forever and can have quite a serious impact on quality of life so perhaps the doctors just want to delay that for as long as possible. Or dad has some other medical condition that would make hormone treatment problematic. 

What are his other medical problems that you mentioned?  

I was also puzzled by the reference to a pellet to shrink the Prostate as this is usually tackled with HT.  Then there is the above reference to possible need for radiation treatment at some point.  Another possible explanation is that the pellet may be Zoladex or similar and may be regularly administered, in which case RT might then be a possibility. Then it could be that Dad was given a tablet to reduce an enlarged Prostate (BPH).

As we have said, it should be established what Dad's full diagnosis was, what treatment was given at the time and is ongoing (if any), apart from monitoring and when PSA tests were done and with what result, also any other scans and detailed biopsies, in other words Dad's full histology.  Dad is said to be concerned about his situation, another reason why he needs to know the thinking of his consultant based on his histology and have an up to date assessment and quite likely establish what is Dad's wish to accept what new is offered now or at some trigger point.