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User
Posted 19 Nov 2023 at 19:33

Hi all


My father is in his eighties and has a lot of health issues. He has now also had two sequential PSA results around 10 with (I think, since getting anything out of him on this is like getting blood from a stone) a six months gap. He had a consultant letter this week talking about a scan for possible COPD and goes on to talk about the fact that "he is not a candidate for radical prostate treatment due to his age" so will go down the AS/HT route. It does not say he has PCA and just says he will have another test early next year.


I am hopping mad because nowhere in this has the urologist suggest a biopsy or a PCA specific at any point. With those numbers, he could be free from cancer or have a nasty beast and we are non the wiser. I think it is idiotic to hold off on the biopsy. Not knowing the Gleason or staging is just playing in the dark.


I would appreciate an opinion from someone who does not have skin in the game.


I have tried to talk to my sisters about it but they are blase (we'll deal with it when it happens etc.) as they have never been through the meat grinder. I want my dad to have the best for his remaining few years, not a last minute catch up because they cant be ar*ed to do a simple medical procedure.


My dad, like most of his generation, simply refuses to talk about it and gets cross when I try.


Yours,


A hopping mad PP.


 

User
Posted 19 Nov 2023 at 19:33

Hi all


My father is in his eighties and has a lot of health issues. He has now also had two sequential PSA results around 10 with (I think, since getting anything out of him on this is like getting blood from a stone) a six months gap. He had a consultant letter this week talking about a scan for possible COPD and goes on to talk about the fact that "he is not a candidate for radical prostate treatment due to his age" so will go down the AS/HT route. It does not say he has PCA and just says he will have another test early next year.


I am hopping mad because nowhere in this has the urologist suggest a biopsy or a PCA specific at any point. With those numbers, he could be free from cancer or have a nasty beast and we are non the wiser. I think it is idiotic to hold off on the biopsy. Not knowing the Gleason or staging is just playing in the dark.


I would appreciate an opinion from someone who does not have skin in the game.


I have tried to talk to my sisters about it but they are blase (we'll deal with it when it happens etc.) as they have never been through the meat grinder. I want my dad to have the best for his remaining few years, not a last minute catch up because they cant be ar*ed to do a simple medical procedure.


My dad, like most of his generation, simply refuses to talk about it and gets cross when I try.


Yours,


A hopping mad PP.


 

User
Posted 20 Nov 2023 at 21:56
Okay - you are probably not going to like this but:
- my father-in-law was diagnosed at the age of 79 and wished he had never known - he felt that it spoilt his last years
- it seems unusual not to bother with the biopsy so perhaps other information has convinced them that it is PCa
- for example, it may be that the urologist could feel the cancer when he did a DRE - but you may not be able to ask your dad whether he had a DRE :-/
- it is entirely possible that dad decided not to give consent for the biopsy
- would your dad agree to put in writing that the doctors can share information with you? If so, you can ask the GP and urologist for more info without dad having to get flustered about it all
- if there is a reason why they are convinced enough to put him on HT, fair enough - but if they are just guessing, I would push for no treatment until / unless there is a diagnosis
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 21 Nov 2023 at 00:28
Agree we don't know enough about the situation, how relevant are Dad's other health problems in terms of how well he would cope and benefit from radical treatment as well as Dad's attitude to PCa should this be the case. Also, it could be that the Urologist has reason for not wanting to do suggest steps leading up to radical treatment but has used the reason that he would be too old for this euphamistically rather than give a patient based reason. In short, a patient should not altermatically be denied diagnosis and treatment just because he is in his eighties. Some men can and do have radical treatment in their eighties if they want it and are suitable.

As has been suggested, I would have a good talk with Dad to ascertain what he feels about going through tests and scans and pushing for radical or systemic treatment depending on diagnosis if he so wishes.
Barry
User
Posted 21 Nov 2023 at 07:54

My father in law was put on hormone therapy without a biopsy after a retention incident that put him in casualty.


He was 85, 12 months later he ended up in a dementia home during COVID and eventually died from a fractured hip without his family around him.


Personally if he is not experiencing significant symptoms I would opt for zero tests AND zero treatment and just focus on enjoying what life he has left.


I believe the HT contributed to his dementia AND his fractured hip.


 

Edited by member 21 Nov 2023 at 07:55  | Reason: Not specified

User
Posted 21 Nov 2023 at 13:29

Absolutely this ⬇️ 


Originally Posted by: Online Community Member


My father in law was put on hormone therapy without a biopsy after a retention incident that put him in casualty.


He was 85, 12 months later he ended up in a dementia home during COVID and eventually died from a fractured hip without his family around him.


Personally if he is not experiencing significant symptoms I would opt for zero tests AND zero treatment and just focus on enjoying what life he has left.


I believe the HT contributed to his dementia AND his fractured hip.


 


"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 21 Nov 2023 at 14:22

Originally Posted by: Online Community Member


My father in law was put on hormone therapy without a biopsy after a retention incident that put him in casualty.


He was 85, 12 months later he ended up in a dementia home during COVID and eventually died from a fractured hip without his family around him.


Personally if he is not experiencing significant symptoms I would opt for zero tests AND zero treatment and just focus on enjoying what life he has left.


I believe the HT contributed to his dementia AND his fractured hip.


 


[/quote


In the case of your FIL, if he ended up in a home due to Dementia 12 months on, his capacity to make a treatment decision would have been questionable at the decision to treat time.  Perhaps nobody had a Power of Attorney for his health?


If a man has capacity, he should in my view be as fully appraised, as well as one can be about his PCa and Pros and Cons of having treatment, bearing in mind how this might affect him.  This would not stop him from consulting others as part of the decision making process.

Barry
User
Posted 21 Nov 2023 at 15:43

My dad was diagnosed when he was 77 years old. He rang me up. He asked how me, the wife, and the grandkids were doing. Then discussed, at great length, the cricket test match. Then moaned for half an hour about government and the state of the country. Then when into great detail about what him and my mum were having for dinner. Then right at the end he said, "Oh and I've got cancer"


He didn't have a biopsy and was advised that he was too old for radical treatment. His PSA was still checked and was given tablets and injections, as he said, "To keep the bugger under control"


He died 11 years later, and apart from peeing a lot at night, he 'soldiered on'  I'm not even sure what was put on his death certificate but I think he died with the disease rather than dying from it.


Like many folk my dad would always take the path of least resistance.

Edited by member 21 Nov 2023 at 18:38  | Reason: Typo.

User
Posted 06 Dec 2023 at 20:19
Hi all.

Sorry for the delay in replying. Thanks for all the kind words and common sense. My biggest takeaway was my reactions were more about me wanting to fix something in someone else that I had no control over in me, because he's my dad.

It took a bit of reflection to realise his situation is very different to mine so my worldview does not apply and more importantly, he has autonomy. I'll just step back and let him play it out how he wants.

To add to this, one of my closest friends has been Dx's with cancer of the lower esophagus with some lymph node involvement. He's doing what I did, hitting Mr Google so I advised him to ease off until he knows more, a lesson I learned the hard way. I gave him some other bits of hard won advice too, so at least something positive came out of my journey.

Getting two people I care about being screwed over by cancer in short succession is quite a kick in the bits, and a little bit of survivor guilt is starting to creep in. Gonna have to s*** that down fast so I can keep on an even keel to be able to help them.

Obligatory **** cancer.

Cheers, all.
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User
Posted 20 Nov 2023 at 21:56
Okay - you are probably not going to like this but:
- my father-in-law was diagnosed at the age of 79 and wished he had never known - he felt that it spoilt his last years
- it seems unusual not to bother with the biopsy so perhaps other information has convinced them that it is PCa
- for example, it may be that the urologist could feel the cancer when he did a DRE - but you may not be able to ask your dad whether he had a DRE :-/
- it is entirely possible that dad decided not to give consent for the biopsy
- would your dad agree to put in writing that the doctors can share information with you? If so, you can ask the GP and urologist for more info without dad having to get flustered about it all
- if there is a reason why they are convinced enough to put him on HT, fair enough - but if they are just guessing, I would push for no treatment until / unless there is a diagnosis
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 21 Nov 2023 at 00:28
Agree we don't know enough about the situation, how relevant are Dad's other health problems in terms of how well he would cope and benefit from radical treatment as well as Dad's attitude to PCa should this be the case. Also, it could be that the Urologist has reason for not wanting to do suggest steps leading up to radical treatment but has used the reason that he would be too old for this euphamistically rather than give a patient based reason. In short, a patient should not altermatically be denied diagnosis and treatment just because he is in his eighties. Some men can and do have radical treatment in their eighties if they want it and are suitable.

As has been suggested, I would have a good talk with Dad to ascertain what he feels about going through tests and scans and pushing for radical or systemic treatment depending on diagnosis if he so wishes.
Barry
User
Posted 21 Nov 2023 at 07:54

My father in law was put on hormone therapy without a biopsy after a retention incident that put him in casualty.


He was 85, 12 months later he ended up in a dementia home during COVID and eventually died from a fractured hip without his family around him.


Personally if he is not experiencing significant symptoms I would opt for zero tests AND zero treatment and just focus on enjoying what life he has left.


I believe the HT contributed to his dementia AND his fractured hip.


 

Edited by member 21 Nov 2023 at 07:55  | Reason: Not specified

User
Posted 21 Nov 2023 at 13:29

Absolutely this ⬇️ 


Originally Posted by: Online Community Member


My father in law was put on hormone therapy without a biopsy after a retention incident that put him in casualty.


He was 85, 12 months later he ended up in a dementia home during COVID and eventually died from a fractured hip without his family around him.


Personally if he is not experiencing significant symptoms I would opt for zero tests AND zero treatment and just focus on enjoying what life he has left.


I believe the HT contributed to his dementia AND his fractured hip.


 


"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 21 Nov 2023 at 14:22

Originally Posted by: Online Community Member


My father in law was put on hormone therapy without a biopsy after a retention incident that put him in casualty.


He was 85, 12 months later he ended up in a dementia home during COVID and eventually died from a fractured hip without his family around him.


Personally if he is not experiencing significant symptoms I would opt for zero tests AND zero treatment and just focus on enjoying what life he has left.


I believe the HT contributed to his dementia AND his fractured hip.


 


[/quote


In the case of your FIL, if he ended up in a home due to Dementia 12 months on, his capacity to make a treatment decision would have been questionable at the decision to treat time.  Perhaps nobody had a Power of Attorney for his health?


If a man has capacity, he should in my view be as fully appraised, as well as one can be about his PCa and Pros and Cons of having treatment, bearing in mind how this might affect him.  This would not stop him from consulting others as part of the decision making process.

Barry
User
Posted 21 Nov 2023 at 15:43

My dad was diagnosed when he was 77 years old. He rang me up. He asked how me, the wife, and the grandkids were doing. Then discussed, at great length, the cricket test match. Then moaned for half an hour about government and the state of the country. Then when into great detail about what him and my mum were having for dinner. Then right at the end he said, "Oh and I've got cancer"


He didn't have a biopsy and was advised that he was too old for radical treatment. His PSA was still checked and was given tablets and injections, as he said, "To keep the bugger under control"


He died 11 years later, and apart from peeing a lot at night, he 'soldiered on'  I'm not even sure what was put on his death certificate but I think he died with the disease rather than dying from it.


Like many folk my dad would always take the path of least resistance.

Edited by member 21 Nov 2023 at 18:38  | Reason: Typo.

User
Posted 28 Nov 2023 at 10:25
It's a difficult one isn't it PP.

My 86 year old father was given the all clear on his prostate cancer and on the same day informed he had cancer of the Larynx. Talk about a high then a low. Following RT this impacted indirectly on his COPD which has flared up and now he is breathless all the time. He hates the idea of going back into hospital convinced it will finish him.

Maybe it's a gentle chat with your Dad and GP or a call to a cancer nurse. I'm in favour of my father having treatment but with maintaing his quality of life being paramount.

Good luck to your family

Mike
User
Posted 06 Dec 2023 at 20:19
Hi all.

Sorry for the delay in replying. Thanks for all the kind words and common sense. My biggest takeaway was my reactions were more about me wanting to fix something in someone else that I had no control over in me, because he's my dad.

It took a bit of reflection to realise his situation is very different to mine so my worldview does not apply and more importantly, he has autonomy. I'll just step back and let him play it out how he wants.

To add to this, one of my closest friends has been Dx's with cancer of the lower esophagus with some lymph node involvement. He's doing what I did, hitting Mr Google so I advised him to ease off until he knows more, a lesson I learned the hard way. I gave him some other bits of hard won advice too, so at least something positive came out of my journey.

Getting two people I care about being screwed over by cancer in short succession is quite a kick in the bits, and a little bit of survivor guilt is starting to creep in. Gonna have to s*** that down fast so I can keep on an even keel to be able to help them.

Obligatory **** cancer.

Cheers, all.
 
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