PSA of 11.7 in 90 yr old man

Biopsy with PSA 11.7 at age 90 ?
1
Is biopsy recommended - 25.0%
3
Is PSA every 3 to 6 months recommended instead? - 75.0%

 
New Topic Post Reply Printable Version
29 posts in this thread.
Viewing Page :
 1  2 
[ << Previous Thread | Next Thread >> ]

Joe's wife
New Member


Date Joined Jan 2012
Total Posts : 6
   Posted 1/17/2012 8:14 PM (GMT -6)   
My husband  just had his annual visit with the same urologist he has been seeing for about 14 years, and his PSAs have been around 6 to 7 something.  The nurse called yesterday and said his PSA was 11.7 and wanted to make an appt. for a biopsy.  Instead we made an appt. for a consultation to discuss whether to do or not to do.  He had an elevated PSA at age 75 and had a biopsy...which resulted in no other action with his former urologist.  We changed urologists about a year later due to a change in our insurance plan and have had annual visits with the present one.
My husband is in much better health than all his contemporaries,
has no symptoms and normal urination frequency during day...maybe 2 or 3 x per night at most.  What would you do if it were your 90 yr old prostate?

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2616
   Posted 1/17/2012 8:28 PM (GMT -6)   
Generally speaking, untreated PC may take 5 to 10 years to cause real problems. Also with his age, prostatitis may also be a real possibility.

I certainly could never advise anyone on what to do, but having gone through the last 3 years post treatment issues, I would most likely go on enjoying life. I might consider Avodart, or something to slow it down. Surgery, radiation, or Hormone Therapy would not be my choice.

Just my personal opinion.

Good luck, and welcome to Healing Well.
Goodlife


Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9 Da Vinci, Cleveland Clinic 4/14/09 0/23 lymph nodes involved pT3a NO MX, Cath and 2 stints for 2 weeks
Neg Margins, blad. neck. PSA 6 wk,<.03, 3 mo. <.01 (dif lab), 5 mo. <.03 , 6 mo. <.01, No pads, 1/1/10, 9 mo. < .01, 1 year .01, 15 mo. <.01, 18 mo. .01, 21 mo. .02, 24 mo. .03, 27 mo. .02 , 30 mo .02.

yaamba
Regular Member


Date Joined Nov 2011
Total Posts : 100
   Posted 1/17/2012 9:11 PM (GMT -6)   
Hello Joe and Joe's wife,

My father in law was diagnosed with Pr. Cancer at the age of 90 too. His PSA was in the 1000s. He went ahead with a rebore (TURP) to help with urination problems, and followed this with a course of hormone therapy. He refused any other treatment (surgery, radiation etc) due to his age. He too was a healthy elderly gentleman. He lived with our family from about the age of 87, so I certainly knew quite a bit about his treatment and follow up and I was the one who took him to appointments and generally his well being.

He came out of the TURP very well, and the hormone therapy, although causing him many hot flushes, were not too debilitating. In fact he had a very active and great life after the rebore, following all his hobbies, and enjoying his daily scotch or two (perhaps three) and with his healthy appetite, he was a pleasure to look after.

F.In. Law died a couple of years ago, at the ripe old age of 103 and it was not from P.Cancer.

cheers
Husbands information:
Age 65
October 2011: 12 core biopsy, 11 out of 12 cores between 80-95% positive
Gleason score of 9 (4+5)
Melanoma Clark Level IV excised September 2011
Heart valve repair 2009

Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1785
   Posted 1/18/2012 7:07 AM (GMT -6)   
Joe's wife, the question that needs to be answered is if your husband has another biopsy and prostate cancer is found, what is he willing to do with that information? In other words, if your 90 year old husband (bless him!) is told he has prostate cancer, is he going to pursue treatment? Perhaps the question to ask during your consultation is what treatment options would be available for a man his age, and what he could expect in terms of possible side effects. Next would come the decision about whether or not Joe would want to pursue treatment if he found out he has PCa. If he wants no part of any of the treatment options available to him, then having a biopsy may be pointless.

This is a tough question and one that only he and you can answer. Good luck with the consultation, and please come back and let us know how it went.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of posterior extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA 0.0 thru July 2009. August 2009 - 0.1, September 0.3, October 0.0. All PSAs <0.1 since October 2009.

RandomPseudoNym
Regular Member


Date Joined Dec 2011
Total Posts : 135
   Posted 1/18/2012 9:49 AM (GMT -6)   
Your poll is missing the answer I'd give (or currently think I'd give) in 43 years...and those 43 years are why my personal choice was drastically different.

X...nothing at all.

Biopsy is more harm than good at his age, IMHO. The real risk of infection .vs. the possibility of confirming a cancer that's probably not doing any harm.

And frequent checking of PSA is a needless fuss once you've passed an age where doing anything more actively about a result stops making sense. If PSA is only 11 at age 90, any PCa is pretty well waving a flag and saying "I'm indolent, if I'm here at all." Trying to treat it is far more likely to cause harm than leaving it alone.

Odds are great that doing nothing is really the best option.
3/9 psa 2.? ••• 3/11 PSA 4.08 ••• 6/11 PSA 3.8? but Free 8%
8/11 biopsy 1 of 12 G6 (5% or 20% - depending on pathologist)
Age 47 - after much research, RALRP/w bilateral nerve sparing 10/11
Post-Path: G6 neg margins, multiple/bilateral, confined to prostate, no perineural invasion, 5%, largest 9mm
12/11 - PSA <0.1

tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 346
   Posted 1/18/2012 11:27 AM (GMT -6)   
Sephie has it just right> NO test or procedure of any kind should be attempted if the doctor and patient are not ready to deal with the possible results. This man should have a discussion with his urologist and perhaps another medical professional. The reason I am skeptical of the urologist is that he is obviously prepared to send this man to a biopsy and a discussion of possible treatment without any thought for the man's quality of life, his personal choices and his age. This is a very bad sign.
I am aware that the office staff made the phone call but the doctor is ALWAYS responsible for these decisions. No excuses accepted there. If the doctor says his staff makes that call based on the test results without him overseeing the situation then I am even more concerned that this doctor is masquerading as a professional.

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3241
   Posted 1/18/2012 12:06 PM (GMT -6)   
------- Legal disclaimer ---- I am not a doc so ignore my advice. -----

What would I do? I would not do the biopsy because I would have no intention of doing anything about it.

I'd consider that PSA result as a wake- up call to enjoy life.

Assuming I feel great for a 90 year old, am financially stable, and have wonderful grand kids I would visit long lost family members, travel, have one of the great grand kids make a Facebook page where I could write stories and record memories and history for the whole family.
I'd do the things I should have done 20-30 years ago: apologize, love, contribute, help someone financially. I might even visit a sperm donation center just for fun.

I'd convince myself that the high PSA number just might be the best thing that ever happened to me.

Jeff
Age: 58, Mar 35 yrs, 56 dx, PSA: 4/09 17.8 6/09 23.2
Biopsy: 6/09 7 of 12 Pos, 20-70%, Gleason 4+3 Bone, CT Neg
DaVinci RP: 7/09, U of Roch Med Ctr
Path Rpt: Glsn 3+4, pT3aNOMx, 56g, Tumor 2.5x1.8 cm both lobes and apex
EPE present, PNI extensive, Sem Ves, Vas def clear, Lymph 0/13
Incont: 200ml/day ED: Trimix
Post Surg PSA: 10/09 .04, 4/10 .04, 7/10 <0.01, 12/10 <0.01
AdVance Sling 1/10/11 Dry

Joe's wife
New Member


Date Joined Jan 2012
Total Posts : 6
   Posted 1/18/2012 12:16 PM (GMT -6)   
Thanks to all for your prompt and informative replies.  Our appt with the urologist is later toay and we feel much more confident  about the questions we should ask during this consultation, having had your input.  I am so thankful that I just happened to stumble upon this amazing website, and will be recommending it to all my friends etc. as a place to go for additional information and encouragement on a variety of health issues.  I wonder if there is a national database where one could find out the statistics for prostate cancer discovery,  treatment, and follow-up results  in various age groups.  It would be interesting to know if out of ___# of
cases of men at age _____ with PSA's of _____, what the follow-up
was with biopsy, etc.   That is one question I plan to ask our urologist.  I feel we will learn a lot today about him and how he handles our consultation.  Will certainly post the results of this next step.  Cheers to all of you and many thanks for your contributions.  My husband's spirits and mine  have certainly gotten a boost
as a result!  Joe's wife.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3716
   Posted 1/18/2012 12:52 PM (GMT -6)   
Joe's wife,
The probability of a 90 year old man having prostate cancer is close to 100%. This is just a fact of getting old. The 10 year life expectancy of one Dxed with PC is about 98%. At this point in time any treatment will surely result in much more harm than good. This is why psa test for men over 75 are not recommended. Don't get a biopsy and don't get any more psa tests and have him live out his remaining years without worry or any other impacts on his QOL. There is plenty of evidence that treatment for PC will not improve survival at all for anyone with less than a 10 year life expectancy. Any urologist that would provide treatment for any man 90 years old with no signs of advanced cancer should have his licence revoked. His chances of dying of PC are close to zero.
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

JM@PCRI
New Member


Date Joined Jan 2012
Total Posts : 11
   Posted 1/18/2012 6:02 PM (GMT -6)   
Joe's Wife,
 
Here's a couple of things that might help you decide:
 
  • Why not re-run the PSA and ask for a free % PSA?
  • Ask the nurse what the estimated size (volume) of his prostate is from the urologist's DRE.  If it's enlarged (or even if it's not), you could consider asking about starting Proscar or Avodart.
  • Will your husband do an MRI?  Prostate MRI is emerging as an excellent imaging, and Medicare is paying for it in most cases - but ask.
  • No one knows life expectancy.  Some days I get tired of hearing experts trying to measure it.  What does your husband want to do?

Good luck.


Joe's wife
New Member


Date Joined Jan 2012
Total Posts : 6
   Posted 1/18/2012 6:23 PM (GMT -6)   
Good afternoon  everybody!  Well Joe and I had our little 15 minute
chat with the urologist.   He seemed to favor and encourage the biopsy  adventure, but we went with  "let's just   hold off with that and do another PSA in 3 months."  He did mention that IF a  biopsy showed "aggressive" cancer we would then discuss some options.  He also said chances were it would not.  I asked him what he would suggest "if it were his 90-yr old prostate" and he laughed....or" his father's prostate"...he said his father was dead..So much for my attempt at cracking through the CYA ceiling..
...which is what most physicians must  feel compelled to do these days...( C their A) since tort reform is so elusive.  Also, in the possibly near future "units" over 70 might  fall into the
"comfort care" category because any other options will not be cost effective for Uncle Sugar    .I'm sorry,  let's not even go there.  Meanwhile our son has 2 good friends who are urologists (one in Tenn, the other in Texas) and is asking their opinions.  And, we will continue to gather all the opinions which come to us on this amazing website.   Big hug to all of you.  Joe's wife 

Joe's wife
New Member


Date Joined Jan 2012
Total Posts : 6
   Posted 1/19/2012 1:48 AM (GMT -6)   
Our son has a good friend in Tennessee who is a urologist and thought you would be interested in his comments as follows:
 
"I think it is possible your Dad has some element of prostate cancer.  In the absence of symptoms (new voiding problems, pain in the bones) it would be unlikely that treatment would be considered at this point.  Not knowing your Dad's overall health, I can't say what I would recommend, but I have biopsied very few people at this age unless they insist  or if they have a much higher PSA or symptoms.  Monitoring the PSA and his symptoms seems reasonable."
 
THANKS FOR EVERYONE'S INTEREST AND COMMENTS.  STAY TUNED!
JOE'S WIFE
 
 

Tigerfan53
Veteran Member


Date Joined Jan 2011
Total Posts : 806
   Posted 1/19/2012 2:03 AM (GMT -6)   
Thanks for the update. I think you're making a wise decision to hold off for 3 months. Perhaps you should consider shopping for a new uro in the interim? Keep us posted.
Diagnosed Dec 2010 at age 53
PSA 5.3
Biopsy: 50% in 1 of 12 cores, Gleason 6
PSA 5.6
RRP on 6/6/2011
9/8/2011 PSA undetectable
12/8/2011 PSA undetectable

Aimzee
Veteran Member


Date Joined May 2010
Total Posts : 1180
   Posted 1/19/2012 3:49 AM (GMT -6)   
Dear Joe's wife, if you and your husband are comfortable with this decision, then it is the right one.  Take this time to do things you may have put off doing and enjoy each other's company.  I wish you both the very best in the coming years!
 
Best regards,
 
Aimzee
Husband Ron, age 63
4/1/10 PSA 5.5 Prostate size = 50 grams
Biopsy on 4/20/10 12 samples. Adenocarcinoma: 3 positive cores on right side - No Perineural Invasion Gleason 6 (3+3) Bone Scan/CT Negative 8/18/10 - Da Vinci Prostatectomy. Post Op: Gleason 7 (3+4) Negative surgical margins & lymph nodes. Both nerve bundles spared. ED a problem /No incontinence. Testicular pain. 10/11 PSA 0.01

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1821
   Posted 1/19/2012 4:01 AM (GMT -6)   
Joe's wife,
generally autopsies (any cause of death) have revealed that the incidence of prostate cancer roughly corresponds to age. What I mean by this is roughly 50% of 50 year olds had evidence of Prostate cancer (Pca) . 60% of 60 y.o. , 70% of 70 y.o. etc etc. That was true of men who have died for whatever reason so is also true of the general population. We would expect that 90% of 90 y.o. have evidence of prostate cancer ---- it is simply a result of a man getting older. Who is going to start doing serious surgery on or radiating a 90 year old man, albeit in good health. If there was anything there at present it is not causing him a problem then I would leave well enough alone. If it does cause a problem 5 or 10 years down the track then there are less invasive treatments to help knock it down again.
Just my 10c worth.
Bill

Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1785
   Posted 1/19/2012 7:23 AM (GMT -6)   
Joe's Wife, glad to hear that you're actively collecting information and using it to inform your decisions. In the "for what it's worth department", I have absolutely no problem waiting 3 months for another PSA.

BillyMac is correct...my OB/GYN told me that it's inevitable that when a man lives long enough, he will develop PCa. At 90 years of age, I would agree with your son's friend that it's likely your husband has some element of PCa and that, at this point, monitoring his PSA is the better course of action.

This was an interesting thread.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of posterior extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA 0.0 thru July 2009. August 2009 - 0.1, September 0.3, October 0.0. All PSAs <0.1 since October 2009.

Joe's wife
New Member


Date Joined Jan 2012
Total Posts : 6
   Posted 1/22/2012 8:04 PM (GMT -6)   
Just heard from our son that his Texas urologist friend agreed with the one in Tenn. that having another PSA in 6 months would be his
suggestion. Our family doctor in AZ also agreed with that decision.
Although we are disappointed that our urologist (of some 14 yrs)
immediately wanted to do a biopsy instead of first suggesting another PSA in 3 to 6 months, we will just continue down the PSA monitoring route.
Changing urologists at this point seems too large a leap, and this one does have excellent credentials and has been in practice over 30 years.
Thanks again to all for your interest ...and comforting advice!
Joe's wife.

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 5873
   Posted 1/22/2012 8:58 PM (GMT -6)   
I would tend to agree with Sephie's comments.
 
I hope all goes well in this rather unpleasant detour.
Moderator - Prostate Cancer
(Not a medical professional)

DaVinci 10/2009
My adjuvant IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

Aimzee
Veteran Member


Date Joined May 2010
Total Posts : 1180
   Posted 1/25/2012 2:58 AM (GMT -6)   
Wishing your husband a positive experience in waiting and doing another PSA in 6 months.  Enjoy your time and may God bless you both!
 
Aimzee
Husband Ron, age 63
4/1/10 PSA 5.5 Prostate size = 50 grams
Biopsy on 4/20/10 12 samples. Adenocarcinoma: 3 positive cores on right side - No Perineural Invasion Gleason 6 (3+3) Bone Scan/CT Negative 8/18/10 - Da Vinci Prostatectomy. Post Op: Gleason 7 (3+4) Negative surgical margins & lymph nodes. Both nerve bundles spared. ED a problem /No incontinence. Testicular pain. 10/11 PSA 0.01

Joe's wife
New Member


Date Joined Jan 2012
Total Posts : 6
   Posted 2/24/2012 12:13 AM (GMT -6)   
My husband passed away very suddenly, without any warning,  of a severe stroke on Feb.5th at Mayo Hospital, AZ.  This obviously was unrelated to his PSA of 11.7.  However, had we taken his urologist's advice and gone ahead with a biopsy, I might have thought that the stress of the biopsy had possibly caused him to have the stroke.  His Advance Directive specified his wishes not to endure  all the treatments of feeding tubes etc.  which would only prolong the agony of watching him die.  Unfortunately, it was not possible to get him into hospice during the 6 days in Mayo before he died.  It has caused me to be a strong advocate for Death with Dignity,,,now available only to residents in the States of Oregon and Washington...
or the Netherlands, I believe.  Our pets can be euthanized so they won't have to suffer the indignities I observed while my beloved husband was in one of the top hospitals in the U.S.  I am still dealing with the unspeakable grief accompanying my loss of this wonderful man.  Good luck to all who responded to this forum.  Your comments were a tremendous help to me and my husband when contemplating the biopsy.  However, fate intervened with a severe stroke causing his death before he would have had a follow-up PSA in 6 months.  Another member of the Greatest Generation has
left on his final journey.  God Bless.   Joe's wife.   

Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1173
   Posted 2/24/2012 1:15 AM (GMT -6)   
Please accept my most heart felt condolences on the passing of your husband. He is in a better place without worry or pain.
I share your opinion on dying with dignity. Hopefully soon we will extend the same kindness to humans that we extend to our beloved pets.
Wishing you peace and contentment.
Mag
Born 1936
PSA 7.9, Gleason Score 3+4=7, 2 of 8 positive
open RP Nov 06, T3a, Gleasons 3+4=7, Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; at SRT Start=0.1,
Salvage RT completed (33 days-66Gy) 19 Dec 08
PSA: in Jan 09 =.05, all tests to date (Dec 11) <.04

Tigerfan53
Veteran Member


Date Joined Jan 2011
Total Posts : 806
   Posted 2/24/2012 2:09 AM (GMT -6)   
So sorry for your loss. Celebrate his life. You and your family are in my prayers.
Diagnosed Dec 2010 at age 53
PSA 5.3
Biopsy: 50% in 1 of 12 cores, Gleason 6
PSA 5.6
RRP on 6/6/2011
9/8/2011 PSA undetectable
12/8/2011 PSA undetectable

Aimzee
Veteran Member


Date Joined May 2010
Total Posts : 1180
   Posted 2/24/2012 2:26 AM (GMT -6)   
I am so sorry to hear of your loss.  May God comfort you and your family.
 
Peace,
Aimzee

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2080
   Posted 2/24/2012 2:40 AM (GMT -6)   
Sorry for you loss.
What a strangely complete thread this proved to be.
(My sister is a nurse in a hospice and I live in the Netherlands so I understand your comment)

I hope you have some wonderful memories.
Alf

PS. For the record I suggest anyone else in the position your Joe was in should do AS, take it very calmly, enjoy his life, his family etc and only think of minimum treatment to relieve any discomfort.
Age dx 48
04/09 PSA 8.6, DRE neg. Biop 2/12 pos. G=3+3
07/09 RALP at AVL Amsterdam
Cath out at 1wk Dry at night
PostOp G=3+4 Bladder neck & Left SVI -T3b. No PNI No vasc.inv. Clear margins
09/09 No pads
11/09 PSA 0.1
03/10 PSA 0.4 04/10 CT.
Summer/10 66Gy SRT
09/10 PSA<0.1
01/11 PSA<0.1
04/11 PSA<0.1
07/11 PSA<0.1
10/11 PSA<0.1
No real ED

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1821
   Posted 2/24/2012 4:17 AM (GMT -6)   
My deepest sympathies for your sad loss. I can only begin to imagine your how you must feel. Having lived to 90 he has seen and been part of some of mankind's greatest calamities together with the most magnificent advances in history. How the world changed in that 90 years. He has more than made made his mark when people say "He was a fine man".
My condolences to you and your family at this sad time,
Bill
New Topic Post Reply Printable Version
29 posts in this thread.
Viewing Page :
 1  2 
Forum Information
Currently it is Thursday, October 02, 2014 9:29 AM (GMT -6)
There are a total of 2,231,954 posts in 248,325 threads.
View Active Threads


Who's Online
This forum has 156891 registered members. Please welcome our newest member, twingirl812.
379 Guest(s), 16 Registered Member(s) are currently online.  Details
DBwithUC, Tricky Dicky, lookinforhelp, Dixie6, kazbern, malaika, Charmy, Scaredy Cat, 142, lovif, ktosh85, psbg, Carole_D, Kitkate, happyjo, iPoop


Follow HealingWell.com on Facebook  Follow HealingWell.com on Twitter  Follow HealingWell.com on Pinterest  Follow HealingWell.com on YouTube
Advertisement
Advertisement

©1996-2014 HealingWell.com LLC  All rights reserved.

Advertise | Privacy Policy & Disclaimer