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AS big jump in PSA what questions do I need to ask?

User
Posted 16 Jan 2025 at 17:51

Hi, my Dad is 89 & been on AS for a year. Never had a biopsy (too scared), bone scan clear. Generally quite active for his age, but suffers with atrial fibrillation / hypertension / diabetes / high cholesterol all managed with medication.

His PSA has risen from 19 July 2024 to 57 October 2024 to 126 January 2025. Urology rang today & given him an appointment for tomorrow. 

What questions do we need to be asking? Are they likely to offer treatment options?

Thank you for any guidance as we navigate next steps.

User
Posted 16 Jan 2025 at 19:31

Hi Debbie, 

At 89 he might not be given many or even any treatment options. Quality of life might be the priority.

I'm 59 and was told they couldn't offer a 2nd run of AS without a biopsy. It was choose a template biopsy or treatment for the MDT to agree.

Having said that the biopsy isn't actually as bad as it sounds. They might push for one given the PSA reading. Has he had an MRI? That would be the typical path before a biopsy.

If the news wasn't good, I'm not sure if they offer just HT instead of surgery. Others might know on here if that was an option.

Edited by member 16 Jan 2025 at 19:53  | Reason: Not specified

User
Posted 16 Jan 2025 at 20:40
Debbie, it must be an anxious time. Those are big PSA rises.

As Ohwow says, at 89 they will want to consider how your father would respond to any radical treatment. It is quite likely hormone treatment (blocking testosterone, on which most prostate cancers depend) would be considered but the side effects and (probably) long recovery time from surgery or radiotherapy might rule those out.

Good luck for tomorrow. It is reasonable for your father to make a choice about biopsy if he wants, to be honest a scan to see if there are metastases seems more relevant (if there are multiple metastases that might rule out surgery and radiotherapy anyway, but hormone treatment should still be effective).

 
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