Father diagnosed w/PCa

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New Member

Date Joined Jul 2009
Total Posts : 7
   Posted 10/8/2009 8:22 PM (GMT -6)   
Greetings All,

My active 89 year old father was diagnosed with Gleason 7 PCa, PSA 21. His Dr. gave two options: 1) watchful waiting and 2) hormone therapy which he recommended. Any info or suggestions would be helpful. At his age I don't think there are many options but if any group would know, it's this one. What are the possible HT side effects?

I found this HW site back in June after my RLP and have gained much wisdom and courage from daily reading.


Veteran Member

Date Joined Jul 2009
Total Posts : 1267
   Posted 10/8/2009 9:39 PM (GMT -6)   
Hi Robert.

I'm reminded of my own father who used to say, "Who would want to live to be 100? ! ! !" Then he'd answer his own question: "Ask someone who is 99."

I have a 96 year old mother who lives on her own and is thinking of buying a new car. Her eyesight keeps her from driving, but she does like to have a car.

Point being, if your dad is in good enough shape generally that the doctor is suggesting therapy for his cancer, then he should probably do the HT treatment ---- although I do wonder if he wouldn't be a perfect candidate for HIFU. It's worth checking out.

My father had his testicles removed and did a hormone drug I believe it was, called flutamide. His breasts grew some, but not to the point that they were an issue in the locker room, or anything, and aside from that, I don't think he had any issues with the drug. Surgery wasn't an option as he had a bad heart -- many heart attacks from age 45 on. And, it was his heart that got him, about 15 years after the PCa diagnosis.

Sorry I can't be of more help, but hope the above might be of interest to you.

How goes with your RLP journey. I too was "done" in June. So far, so good, for me.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9, so far, so good
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
First post op PSA Sept 09  0.02
Oct 1st 09 -- dry at night, during day some stress issues, but better every week.    

Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 10/9/2009 5:33 AM (GMT -6)   
They say 80-90% of men either will be or could be diagnosed with PCa at age 80-90 (i.e. it is common to have it show up, the amount of it is a big variable). At his age invasive protocols and such are probably not in his quality of life interests, is my s.w.a.g. Maybe some type of hormone therapy, although it can have side effects, perhaps casodex is the easiest route.

Oriectomy is not really necessary, although some people have done such and it can render results, but is not intermittent (LOL), you can go on and off hormone therapies (drugs).

There are some older guys that say f.u. to all of it and do about nothing and usually die of heart diseases and other ailments.
 "I wouldn't join a club that would have me as a member" (Groucho Marx)

Veteran Member

Date Joined Feb 2008
Total Posts : 655
   Posted 10/9/2009 5:38 AM (GMT -6)   
Greetings, Robert.  As Zufus said, virtually all men will come up with a diagnosis of prostate cancer in their 80s if they look for it.  I'm not as familiar with hormone therapy but it does seem that would be the option if he chooses to do anything at all.  Most likely, something else will pop up before the prostate cancer can get him.  David

Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me

Steve n Dallas
Veteran Member

Date Joined Mar 2008
Total Posts : 4849
   Posted 10/9/2009 7:26 AM (GMT -6)   
How long did your Dad's parents live? Does your dad have any brothers and if so, what kind of shape are they in?
Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.

Veteran Member

Date Joined Apr 2009
Total Posts : 990
   Posted 10/9/2009 10:15 AM (GMT -6)   
Do you know if your dad's Gleason was 4+3 or 3+4? The second would be better for watchful waiting. My dad had his testicles removed and died of a stroke at 86. In between he lead an active life with his biggest complaints being night sweats (he would just wash the sheets every morning) and the need for an afternoon nap. At your father's age one wants to be very careful to preserve quality of life.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads

New Member

Date Joined Jul 2009
Total Posts : 7
   Posted 10/12/2009 10:24 PM (GMT -6)   
Thanks for all the replies.

Sleepless -I'm making progress on both fronts but most importantly my PSA was <.1!

Steve- He has outlived both siblings and going strong physically. Mentally he is slipping but has a good attitude.

Geezer- His Gleason is 3+4 and yes, we are making sure the quality is still in the equation.
routine yearly physical PSA 7.9
biopsy positive 04/2009
Da Vinci @ Vanderbilt 06/2009
Gleason 3+4
PSA 08/2009 0.1

Veteran Member

Date Joined Jul 2009
Total Posts : 1267
   Posted 10/12/2009 10:45 PM (GMT -6)   
Robert --- Congratulations on the PSA ! You must be feeling great.

On your dad, at 89 in 11 years he'll be 100 and chances are, like the rest of us, that will be pretty close to the end of the road. Before I did any treatment I'd want to understand how likely it was that this 3 + 4 had any chance of being an issue for him in the next 11 years.

I'm 67 and also a 3 + 4. My doctor said if I left mine untreated it would be 10 to 15 years before I had any problems as a result of the PCa. Who knows where he got those numbers and how good they may or may not be. But if your dad's cancer isn't going to be an issue for 15 years (I've read PCa moves slower in those over 80) then perhaps doing nothing is a reasonable option.

But don't take medical advice from me! I'm just ruminating.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9, so far, so good
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
First post op PSA Sept 09  0.02
Oct 1st 09 -- dry at night, during day some stress issues, but better every week.    

Regular Member

Date Joined Jun 2008
Total Posts : 407
   Posted 10/12/2009 11:23 PM (GMT -6)   
I have some elderly male neighbors.  One, a 90-year old/young guy had his prostate removed.  Another, recently, at 101 had his removed - both for prostate cancer reasons.  "Watchful waiting?"  Who decides?  The patient, that's who.  Both of the men I mention here wanted a better quality of life - no matter how many years that would be.  The 90 year-old passed away two years after the prostate removal - due to other problems.  The 101-year old is about to turn 102, and is thrilled to have rid of his prostate . . . and is looking forward to his birthday party.  If his health is reasonably good - your father should do what he wants to do.  It's his choice and the family should support him.

Age:  60 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (1/2 light pads per day)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0; 12/08: 0.0; 4/09: 0.0; 9/09: 0.0


Veteran Member

Date Joined May 2009
Total Posts : 2692
   Posted 10/13/2009 8:30 AM (GMT -6)   
These are really tough ones. Just recently admitted my 87 yr old mother for low hemoglobin, and bleeding. Our family had to decide how far we go to preserve life, considering her mental status. Fortunately, they just gave her some blood, and changed her meds and sent her back home.

With Lupron costing a $1000 a shot, and with the side effects, particularly in olde patients, one has to wonder what is best. Just wish it was a G6. Still, the odds are before it metastisizies and gets to other organs, he most likely will have issues with heart attack, stroke, etc.

I can only say if it were me personally, and I was his age, i would most likely say leave me alone, and don't screw up the remaining years of my life with Dr. visits, side effects, and all the rest that goes along with PC treatment.

Best of luck to you in this situation.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)

Elite Member

Date Joined Oct 2008
Total Posts : 25394
   Posted 10/13/2009 9:06 AM (GMT -6)   
Goodlife, knowing what I know now about PC, and if I were that age too, I think I also would "watch" it, as there are myriads of other common reasons my life could end at that age. Be a shame to destroy whatever quality of life this dear man has left in an attempt to prolong it somewhat. These are always tough ethical subjective calls to make.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - began IMRT SRT - 39 sessions/72 gys.

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4269
   Posted 10/13/2009 12:08 PM (GMT -6)   
Your dad could try hormones and if they affect his quality of life he coud stop and undergo only a few months of discomfort. Many older patients have few side affect from HT and he could be one of them.

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.


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