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Re: Is surgery a good option for my 74 year old father?
I was 59 and had a prostatectomy. My gleason was 3+3=6, PSA 6 after biopsy. The cancer was in the fatty tissue outside of prostate and gleason was upgraded to 7. I am now scheduled for salvage radiation due to a rising PSA, 18 months later. You won't know for sure that it is contained until after surgery. I would talk to a radiation oncologist prior to making decision. Good luck and tell your dad not to get discouraged. Learn all you can and you won't be so fearful.
Re: Is surgery a good option for my 74 year old father? (Lots of additional info from Dr. Walsh)
Hi Sandy,
In addition to the excellent & thorough advice you have gotten so far, I thought I would give you some additional insight from the world-renowned urologist/surgeon Dr. Patrick Walsh from Johns Hopkins Hospital who authored THE book on Prostate Cancer (PCa) entitled “Guide to Surviving Prostate Cancer”. Despite being an open radical prostatectomy (RP) surgeon, the book gives a surprisingly objective look at the different treatment options and even recommends that some patients not seek treatment due to their age & overall health. I am going to give you some excerpts from this book as it relates to your father, but it would be worth your time to obtain a copy. If you do, you will find that it is written in layman’s terms so it is easy to understand.
First of all, Dr. Walsh believes that those seeking treatment should have at least 10 years of life expectancy left & be in overall good health. (I want to add that this view is shared by the U.S. Preventive Services Task Force (USPSTF) & other similar organizations around the world). In a quote from the book, under the heading “Men Who Probably Don’t Need to Be Cured”, he says: “To put it bluntly, at the top of the list should be men who are too old or too ill either to undergo the rigors of treatment or to live another ten years—long enough for such treatment to be worthwhile. These men are very unlikely to die of prostate cancer, and if the cancer progresses, their symptoms can usually be managed well with hormone therapy. Also, in this group should be men who don’t want to experience the side effects associated with surgery or radiation”. For these patients, he recommends “Expectant Management” or “Active Surveillance” (AS) as it is often called.
As far as surgical complications are concerned, he has this to say: “In men over 70, surgery carries a higher risk of incontinence & impotence”, but he adds that the side effects of surgery are highly variable, depending on the skill & experience of the surgeon. (Danny & Terry have already given you excellent advice on finding one of the best doctors in his field despite which treatment option you choose).
In regards to the effectiveness of RP, you don’t need his book to google “The Hans & Partin Tables” put together by the doctors at Johns Hopkins. You didn’t say what your father’s clinical stage is (it sounds like T2c, meaning the cancer is palpable & involves both lobes, but I can’t be sure). With the clinical stage and the knowledge that your father has a PSA of 20 & a Gleason score of 7 (4+3), you can use The Hans Table to determine the likelihood of having no detectable cancer at 10 years following RP. (If he is a T2c, the likelihood of being cancer free at 10 years is 59%). The Partin Table uses the same information to determine the extent of the cancer (or pathologic stage as it is called). For example, it will give you the likelihood that the cancer is organ confined, and in the case of a T2c with your father’s PSA & Gleason stats, it is only 11%. It also gives the likelihood of extraprostatic extension (or capsular penetration as it is sometimes called), as well as seminal vesicle & lymph node invasion. It should be noted that this information is based on 5000+ J Hopkins patients & therefore should be considered a best case scenario since JH is one of the best hospitals for cancer in the country.
The Doctor has this to say if a man is in his seventies & the Tables suggest that cure is unlikely: “The question here is whether a man who may not live long enough to die of PCa should be put through an operation with an uncertain likelihood of cure. Surgery has more side effects in people in their seventies. So, for this man, radiation therapy is a better, more reasonable option”.
Lastly regarding age, he talks about how a family history of longevity, low blood pressure, not having diabetes, not smoking & having no history of heart disease may cause you to live long enough to need to be cured. (I should add that he states that AS may be a better choice if the patient has trouble breathing). For the record, one website I checked out lists the average life expectancy for a man in the USA to be 75.6 years, but of course, many men live a lot longer than that. My Dad, for example, is well into his eighties and going strong. I wish your father the same longevity.
Re: Is surgery a good option for my 74 year old father? (Lots of additional info from Dr. Walsh)
I am 75 and three years post-treatment. My ongoing journal thourghly documents my experience. You and your father may find it helpful; see http://protondon.blogspot.com/
Regards Don O.
Re: Is surgery a good option for my 74 year old father?
Just wanted to thank everyone for your kind responses to my earlier query. Also, an update that my father opted for Laparoscopic Prostatectomy. Surgery will be conducted by an experienced surgeon. It is scheduled for the first week of March. Please pray for my father and send positive thoughts his way, for his full and speedy recovery. Thank you again! Sandy
