mental health

my dad at 83, had a breakdown leading to MH unit admission for 4 months. I think perhaps not knowing would have been better as he lost four reasonably healthy months sort of wasted  in there and passed 6 months later at 84. In his case there was treatment offered but he was sadly mentally unable to deal with the situation. 

Hi sioux. 

Consultant said as dad is 85 there wouldn't be treatment anyway.

This is not really correct. Your dad probably wouldn't be suitable for radical treatment (surgery, radiotherapy) because of his age and mental health. My dad was diagnosed about the same age and was put on hormone therapy which kept the prostate cancer at bay until he passed away at 93 from other causes. Unfortunately if your dad is unable to tolerate a DRE and MRI scan then a diagnosis is not going to be possible.

It is a somewhat difficult question, because it is an ethical question. Fifty years ago it was considered acceptable for people who new what is best, to make decisions on behalf of people who wouldn't have made the right decision themselves. If you look at forced adoptions, forced sterilisation, experimentation on servicemen you can see that it is not a good route to go down.

Of course we don't allow children or the insane to make important decisions, probably with some justification.

If your dad is not informed he cannot make decisions about HT which is a possible treatment, also if he knows his life is limited he may want to spend it on holiday, or chasing fast cars and fast women; good choices, but ones he can't make without all the information. 

You consider a cancer diagnosis may impact his life so badly that it outweighs his right to make informed choices. If you know the diagnosis and he doesn't you will have to continue making choices on his behalf without his consent.

The following is my personal opinion. If he can't know his diagnosis I wouldn't want to know it either, because there is no way I would want to be making decisions for him or preventing him making informed decisions. I would want him to stop the diagnosis process, now.  

I have LPA for mum but not dad as he couldn't face answering the questions about his wishes (eg life sustaining treatment) on the forms!  He did, however, give permission to the doctors for them to deal with me and thankfully, probably because of his MH history, they are taking notice of that.  

thanks for your input

This is a difficult one, and one I nearly faced with dad in his late 80's when they thought they might have made an incidental discovery of prostate cancer bone mets on a CT scan for something else. Fortunately, further investigation dismissed prostate cancer.

A question you might ask is, in the absence of prostate cancer, how long do you expect dad to live? You could then ask his consultant how long he might live with the prostate cancer untreated. If the second exceeds the first, you might choose to leave it untreated, except both are only guesses, and they could be significantly wrong.

Another option would be watchful waiting. Basically, wait until he has some symptoms, and then start treating. It might be that he could start on Bicalutamide tablets at that point (a mild hormone therapy drug). It typically works for 6-24 months, stopping and even slightly reversing the cancer growth. It doesn't cause as many side effects as the more powerful hormone therapy injections. In particular, it doesn't cause osteoporosis when used by itself without the hormone therapy injections (actually quite the opposite - it strengthens bones).