Treatment, or not

Is this his first PSA test. It would be good to know how fast his PSA is increasing. It is quite possible he has had prostate cancer for 20 years if that is the case it is probably progressing so slowly he will die of something else sooner.

I would seriously consider monitoring it for a few months to delay any treatment decision. If it has already been monitored and treatment is being recommended then at 86 ADT is probably the best type to have. One advantage of ADT is that he can stop the treatment very easily if the cure is worse than the disease.

Once you get to old age, it can be a case of choosing what you want to die of rather than thinking you will live forever.

But it is possible that ADT of whichever form, in order to shrink the current tumour as well as stop cancer progression, is the best way of resolving the urine retention. As Andy says there are undesirable side effects in older patients, he mentions the effect on bone (and suggests a strategy) but in a patient already frail I would also worry about the way it tends to weaken muscles.

I think that we can all agree that for an 86-year old patient with other conditions, you need to think about what is kindest for your dad. It may be that it is kinder to start ADT sooner rather than later to sort out the urine retention. Treatments aimed at a "cure", which can be pretty stressful for younger patients in much better health, would be cruel unless they are needed to reduce a source of pain. ADT does have side effects, I experienced low stamina as well as weight gain and loss of libido, but it would also give reassurance that the cancer isn't likely to progress further and cause pain.

Hormone therapy (Bicalutamide or injections) will also shrink prostate significantly over the first 3 months, which might help solve the retention problem. I presume he's already on an alpha blocker such as Tamsulosin (although there are better ones for elderly people).

Basically my reading is that the urine retention is your father's issue which causes the biggest problem, and if the consultant concludes ADT is the most promising way to deal with it you should probably go with that. The downsides are probably going to be minor in relation to the benefits: it will also mean you (and he) don't need to worry about the cancer progressing, and there is a possibility it is a factor in the low kidney function and there might be some recovery in that. As I said above, do whatever is kindest.

I was only on it a couple of months and could have filled an A cup.

Joking apart mate. My dad was in his late 70s when he started hormone therapy. I think he was deemed too old and frail for biopsies and radical treatment. He carried on, much as normal, for 8 years. Good luck to you both.