Treatment decision age 70

Right Ned, I don't fit your age parameters but I'll post anyway

Dec 2020:

Age 66

Gleason 6 (3+3)

PSA 5.6

Only 2 out of 15 cores

T2A

Offered RP, RT and HT and AS. MDT recommended AS. I took that option on their advise

Sept 2022 

Age 67

PSA 6.6

Gleason (4+4) Later upgraded to Gleason 9 (4+5)

20 out of 24 cores

T3a

RT/HT or surgery. Opted for surgery, it was quicker and I couldn't face 37 hospital visits in 7 weeks for RT.

However, had the new, only 5 zaps of RT, been available, I'd have probably taken that.

Edited by member 19 Feb 2024 at 15:17  | Reason: Additional text.

Adrian,

It’s helpful to see how quickly your 3+3 went to a 4+5. I read so much about how slow things are and I would have believed a 3+3 would follow that. What is really significant to me is that you could still have Surgery. Had it metastasized at all? I would like to think I could take a year to sort things out.

Ned

Hi Ned,

The speed at which my disease apparently progressed alarmed me. I was fuious when I discovered that following my first biopsy in Dec 2020, I should have been given a 6 month follow up MRI but this had been overlooked. I was also told that it was likely that the first biopsy missed the more aggressive cancers cells

When I eventually got the follow up MRI and biopsy which was 14 months late, it showed I was Gleason 8 (4+4) in 20 out of 24 cores and that the cancer had just breached the prostate capsule. Following the prostatectomy it was upgraded to Gleason 9 (4+5) but this may have been caused by them putting me on Bical for a couple of months pre op .

I'm not medically qualified Ned. If your doctor deems it safe to leave you for a year before considering other treatment, then do so. But ensure that you have all the tests to ensure you're safe during that period.

It would be wrong of me to advise what course of action you should/could take.

Fortunately, to date, I have no detectable PSA, but there's obviously still a chance of recurrence.

My bone scan pre op was all clear.

Edited by member 20 Feb 2024 at 05:29  | Reason: Typo

Adrian,

I very much appreciate your comments.

Appreciate your input. Just received by Decipher test results yesterday. Just barely under advanced. Was still barely intermediate. I am totally leaning surgery but want to wait until mid September for personal convenience reasons. Daughter back to college and celebration of our birthdays. It seems waiting around six months is fine.

I had my surgery  on 19 of this month. Cathito out next Thursday and am hopping  to be 80% fitt by September. Best of luck

Hubby has just had his prostatectomy on Fri 22nd March at age 70.  His gleason scores showed all 20 cores but one were majority 3+3 with one at 3+4.   He was still given the choice of AS, surgery or HT/RT but was warned if he went the AS route his options would diminish with age.  If the cancer had only been in one or two areas he may have decided on the HT/RT route but even the consultant said he would choose surgery so that's what he decided on.  Catheter is being removed Thurs 28th and believe me he cannot wait!

Mal,

a concern I do also have is the surgery recovery over the initial month. If you would not mind sharing updates as you just had your surgery.

Thank you.

Hi Dave

Yes I used the word "gently" for obvious reasons.     I would not even consider using gentle use of a penile pump if I was incontinent or getting any pain or still on any painkillers.     I stopped painkillers 3 days after the operation.     As a vet,  I never advocated any rehab exercise until an animal was off painkillers.   Pain is there for a reason to protect an area from further damage.     But I think if one is sensible,  then gentle penile rehabilitation can be useful.    Also doing something is better than being told to do nothing and just wait.     Again using the vet analogy,   it was often better to get clients to do something with their animals,  whether cold hosing a swollen leg on a horse or daily light walking exercise because they psychologically were more positive with doing something.   

So that is just my take on recovery and I am sure everyone is different.    I think often recovery protocols in the NHS are standardised and my feeling is that they possibly are tailored for those on the slowest recovery pathway.     I tried in my professional life to give a recovery plan which was individually tailored to the animal.    But we were not under the time or economic constraints of a doctor or health professional in the NHS so it is easier for them to use a "one size fits all approach".  

Mark

Hi Ned

Yes recovery going well.  Had follow up PSA at end of May and it was >0.01 so well pleased with that.    Met surgeon at post op consult a few days after that PSA test on 30th May and he was very pleased with my progress.  No sign of breakout from prostate on histology of the removed organ.  He did not take lymph nodes or biopsy them as the PET scan I had before surgery did not indicate any spread away from the prostate.  MRI was also negative for spread.   No incontinence issues whatsoever but still have ED.  Pump helps and on 20mg Talalafil every 4 days for 3 months.   Use the pump at least twice weekly.    Surgeon suggested 5mg every day but I do get headaches with daily dose so changed myself to 20mg every 4 days (only get headache issues one day in 4 then).    Have tried Viagra and sometimes helps a bit (50mg single dose) but not always.  However still early days on the ED front.     Feel physically 100% and planning next holidays in November to India.   Feel very lucky compared to others.   Good luck.   Mark

Ned,

I have just read throgh this thread again and what you originally requested omits a very important factor, that of staging, because this can rule out some treatments if advanced. Prostate Cancer is a complex disease comprising different types of cancer which can progress in different ways in ivairious individuals and may respond differently to varioustreatments at different times. So due to nuisances it is difficult to form set opiniions on what might be best for an indidual by way of treament. There are plusses and mimuses with all treatments, further compounded by the severity of potential side effects, so it's not possible to say what is best due to diverse factors and how a man evaluates these. Many have found the information gven in the 'Tool Kit' to be helpful in forming their opinion on what is rightt for them, which also takesinto account individual suitability. https://shop.prostatecanceruk.org//our-publications/all-publications/tool-kit?limit=100

Barry,

You are absolutely right about the nuances in each one’s specific case. Even then treatment protocols continue to change it appears over time from more aggressive approaches to everyone to lesser treatments as even today researchers learn more. I am sure as with any treatment many would wish they had more time to wait for more advanced newer treatments maybe less aggressive even for higher grade. I had lymphoma 20 years ago and have seen all the treatment protocols have changes and new drugs introduced. I am scheduled for surgery Aug 15th. The Surgeon wishes to take out lymph nodes for biopsy although my PET shows nothing and only mild uptake 3.1 and 3.6 in each lobe. He talks about microscopic infiltration not seen in a PET. This is all due to one core of Gleason 8 4+4.  Everything else was favorable. Only one 7 3+4 and 6’s. This is for possible adjuvant radiation plus hormone treatment. Now I read there is really lack of good solid studies on adjuvant treatment right  after surgery or waiting and then having salvation treatment when it appears. The long term life outcome in each case seems to be not too different. I am hesitant to have multiple nodes removed for possible lymphedema. I actually have a follow up with the surgeon next week to just go into more detail and discuss the lymph node dissection. It seems because of the Gleason 8 protocol calls for lymph node dissection. I don’t know if he would be willing to put more emphasis on the PET showing nothing and not remove them or ethically he feels he has too. Another option I want to ask is if he could just take one or two closest nodes and not the multiple nodes that may not have anything. Another option I want to ask is whether it’s possible for prior to surgery can they access the nodes by a fine needle biopsy, or even during surgery without the nodes coming out. My decipher was 60 intermediate, and the Surgeon says yes, but 61 puts me up in the higher grade. Then though i pointed out a graph documenting accuracy of decipher showed not that many in the Gleason 8 showed up in the 61 to 70, but then jumps alot above 70 to 8’s, 9’s and 10’s. I am still going forward but think after I heal from the surgery if they want me to proceed to adjuvant radiation I might decline and wait for salvage. 
Ned