Should I try for Prostate removal

User

Posted 13 Jun 2023 at 20:02

Hello all

I was diagnosed with prostate cancer July 2021 My age is 76 years

With a PSA of 2.1,,, Gleason grade 6 a suggested a T" disease with no enlarged lymph nodes and went on to

active surveillance.

Last MRI scan in December 2022 showed PIRADs 4 Lesion and showed no size difference in size from December 2021 MRI scan. All PSA tests have been 2.1 and one 2.2 up to Nov 2022. This March PSA test showed a rise to 2.7.

Of Late I have see on various forums that a lot of guys are going for the radical prostatectomy.

As my last PSA was a bit higher I am now wondering if I should now push for this surgery.

Next PSA is due later this month.

Les

User

Posted 21 Jun 2023 at 01:40

For surgery you need to pass a premedical exam which includes aspects concerning heart which would be more stringent for robotic surgery. Older men may struggle in this respect.

Barry

User

Posted 21 Jun 2023 at 15:35

If the cancer metastisised, you wouldn't be offered surgery anyway.

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

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User

Posted 13 Jun 2023 at 22:09

Gosh - why would you do that to yourself? Your AS seems to be being managed properly - they haven't avoided offering you a new MRI to check what is going on. Your MRI indicates that there is very little change in your tumour - that's often the qay with a Gleason 3+3 which tends to be low risk and not particularly motivated to move around. Your PSA is fairly stable - that rise could be down to aging as much as to do with cancer.

Surgery has side effects - the risk of side effects is greater as you get older. At 76, you may not be suitable for keyhole surgery (depends on your heart) which would mean open surgery and a much longer recovery period.

If you were my dad, I think we would be celebrating another successful year of avoiding radical treatment

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

User

Posted 14 Jun 2023 at 09:21

As LynEyre says, you do not sound like a candidate for the prostatectomy. Certainly during my consultations, the surgeon made a point of remarking that it was my preferred solution 'due to my age' (62).

The side effects are not insignificant and I imagine become more and more serious with age.

Stick with the advice of your consultant and enjoy life.

User

Posted 14 Jun 2023 at 18:48

Hi Les, As said above it might be premature to go for treatment now. Although maybe you should ask about what alternatives to surgery there are if it gets worse. There are less invasive treatments like Brachytherapy that may be more suitable. You might also ask what age the surgeon will perform surgery as someone I know was told it was mid 70s.

It might sound morbid but you might consider how long you expect to live. Reaching 76 with a low grade and low psa means for most the probability of dying of something other than PCa is more likely. Almost any treatment should take you to 85. You can never be sure I regret having to add. All the best.

User

Posted 15 Jun 2023 at 19:26

There are indeed alternatives to RARP and RT, both of which can have severe side-effects, such as HIFU and cryotherapy which are much less invasive but are generally only available in private hospitals at the moment, and also there's a chance the treatment may need to be repeated later on. At the age of 74 (last year) I was diagnosed with T2a N0 M0 Gleason 3+4 (lesions in both lobes) with recommendation from the local hospital for active treatment but after obtaining a second opinion on the biopsy slides from The Christie the score was reduced to 3+3 with active surveillance being the preferred first line option. A second MRI scan last month showed "no change whatsoever" in the appearance of my prostate from the first 10 months earlier and my PSA levels have remained stable at around 10 (I have a very enlarged prostate). I do believe age is a significant factor in prostate cancer and, as they do say, at our time of life most men die with prostate cancer than from it. Best wishes, Julian

User

Posted 17 Jun 2023 at 07:26

Retzius sparing RARP + NeuroSAFE worked really well for me but I’d listen to your urologists advice and maybe as part of due diligence get a second opinion.

User

Posted 17 Jun 2023 at 11:08

Listen to Lyn.

I had surgery at 71 because all the factors pointed me in that direction. I was very fit with no other health issues but my recovery was very tough. At your age chances are the tumour is a slow growing one. I am sure you have heard the phrase 'many men die with prostate cancer but not because of it'!

A friend of mine, a medical doctor, who died a years ago of heart attack at the age of 79 was suffering from prostate cancer for sometime but decided not to treat it because his prostate was not causing any problems.

Good luck.

'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.' Richard Feynman (1918-1988) Nobel Prize laureate

User

Posted 20 Jun 2023 at 15:35

At age 75 with Gleason 3+4 I’m at the stage of deciding the way forward in the next week. My PSA is 1.4 and has not risen in the past 18 months. As my cancer is localised, I’m going to opt for active surveillance but if the situation changes I don’t know if, due to my age, surgery would be offered. I have been offered robotic surgery or radiotherapy. Would those options disappear as I get older.

User

Posted 21 Jun 2023 at 01:40

For surgery you need to pass a premedical exam which includes aspects concerning heart which would be more stringent for robotic surgery. Older men may struggle in this respect.

Barry

User

Posted 21 Jun 2023 at 09:10

Thanks Barry

OK on my last pre op assessment a few months ago for the template biopsy under general anaesthetic. I have several other medical probs, diabetes and Barrett’s so my option to continue on active surveillance may mean that I won’t be in a fit state for surgery if the cancer metastases.

User

Posted 21 Jun 2023 at 15:35

If the cancer metastisised, you wouldn't be offered surgery anyway.

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

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