PSA of 11 to 12 in 88 year old man

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Betska222
New Member


Date Joined Mar 2010
Total Posts : 2
   Posted 3/18/2010 12:14 AM (GMT -6)   
I'm hoping for some info here.  My father's PSA has risen three points in six months from 8.5 to 12.  His doctor wants to wait and retest in six months.  His doctor has been monitoring him for 18 years.  My sister, who's a nurse, wants to get a bunch of second opinions.  My father is suffering from no pain,  but does take some medication to help him urinate more freely.  Anyone here with any experience/advice to share on just how much testing etc. should be done on an otherwise fit 88 year old man?  Thanks!

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4829
   Posted 3/18/2010 4:13 AM (GMT -6)   
Welcome to the site.
 
I would look at it from a quality vs. quanity of life thingie...At his age - why subject him to anything in the way of treatment.
 
I have a good friend that was monitored like you dad was...My friend 75 year old friend broke down and did raidiation treatment mainly due to the fact that both of his 98 and 99 year old parents are alive and kicking. He has a reasonable expectation to live that long.
Age 55   - 5'11"   215lbs
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
11/20/09 - 18 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 3/18/2010 4:19 AM (GMT -6)   
Your call but tests you can analyze like: PCA3, fPsa, PAP, Pyrilinks, Color Doppler Ultrasound and other blood markers (See Dr. Strums book-A Primer on Prostate Cancer a wealth of real info) might be worth investigation...realize how wild PCa is...less than definitive all over the place...biopsies can even be mis-read, go unfound in the gland, and have  variations within a given Gleason score because of ploidity analysis and maybe even a variant type of PCa that was not interpretted correctly (this stuff happens). Sorry to say it is basically how wild it is.


Youth is wasted on the Young-(W.C. Fields)


Sephie
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Date Joined Jun 2008
Total Posts : 1804
   Posted 3/18/2010 4:23 AM (GMT -6)   
Betska, frequent urination at 88 years of age is par for the course. I understand your sister's desire to have additional tests but, frankly, I wouldn't do it. As Steve said, at 88 years old, you need to think about quality vs. quantity of life. Has your dad voiced his wishes as to whether or not he wants further testing.

I wish you luck with this as it's a tough decision.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009- 0.1, September 0.3, October back to 0.0, December 0.0. Thank you God!


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 3/18/2010 9:47 AM (GMT -6)   
Betska,

There are many possible root causes for a PSA rise, most of which are non-cancerous causes (in other words, the PSA test is not “specific” for prostate cancer). A sudden rise is most typically caused by an infection. A sudden rise is most typically not cancerous because the cancerous cells simply don’t usually multiply that fast in prostate cancer—PC is different from other cancers in that the growth is typically slow. Besides growing slow, there is a long time between possible “detection” and “clinical disease” (symptoms).

That being said, his earlier PSA level of 8.5 is also higher than normal. I would guess that there has been previous discussion between your father and his doctor (who has been monitoring him for 18 years) about this elevated level, and I believe that additional history is very relevant in context of any decisions made today. My guess is that if an 88-year old had a test just 6-months ago, then he was already under an informal “watch.”

Many medical personnel intimate with PC don’t advise continued PSA testing for men over 75-years of age (particularly if their PSA results at 75 are low) because the symptoms are so slow growing that the vast majority of men will live the rest of their lives without feeling any ill effects. Of course, as mentioned above the PSA test is not specific for cancer, and so the only way to truly know if PC exists is through biopsy findings. Most doctors would agree that it is irresponsible to initiate a biopsy on an 88-year old man for PC when he is showing no symptoms. Furthermore, besides the fact that most PC is very slow growing, the effectiveness of attempted curative treatment for PC among men 75 or older appears to be low or negligible.

Here’s a link to a relevant reference paper in the New England Journal of Medicine: http://content.nejm.org/cgi/content/full/359/24/2515

engineer55
Regular Member


Date Joined May 2009
Total Posts : 121
   Posted 3/18/2010 9:55 AM (GMT -6)   
Next step would be a biopsy which are no fun, I would wait.
Dx'ed 5/08 one core 2%  out of 12  3+3 gleason
DREs all negative
PSA was in the 3-4 range then jumped to 7
I have the enlarged prostate, on the order of 100cc.  After taking Avodart for 3 months  my
PSA was cut in half.
I did Active S for a year but concluded that I didn't want a life
of biopsies and Uro meetings.
DaVinci on 6/24/09  UCI Med Center  Dr Ahlering, long surgery based on size and location
Final was 5% one side all clear, but had a huge 90 grm prostate
Now we work on pee control, ok at night but sitting is a big problem.


John T
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Date Joined Nov 2008
Total Posts : 4223
   Posted 3/18/2010 11:18 AM (GMT -6)   
Why would you ever consider doing anything? Even if he was discovered, to have PC any treatment would have drastic side affects on his quality of life and most likely not affect his years of survival due to PC, but shorten them do to treatment affects.
There are virtually no deaths from prostate cancer within 5 years of diagonosis and these are from very agressive cancers that most likely wouldn't have responded to treatment anyway.
He can have another 10 good quality years of life without treatment or 10 years of fighting side affects of radiation or hormone therapy. The end result will be the same, the journey will be quite different.
Treatment like HT will definately shorten his life from other causes such as cardiac or bone issues. Surgery is out at his age, and radiation could have severe problems to his bowels and urinary system.
JohnT

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.

JohnT


Betska222
New Member


Date Joined Mar 2010
Total Posts : 2
   Posted 3/18/2010 11:34 AM (GMT -6)   
Thank you all for your replies. I really appreciate how quickly and how thoroughly you discussed this for me. You're a great group of people!

My initial reaction was that at 88 he would probably die from other causes sooner than PC. His quality of life is excellent now, except for a shoulder problem. He is mobile, still drives, still has all his marbles (!!), still lives in his own home. He is fine with waiting because he has no other symptoms. My sister thinks that every twinge or stumble or forgotten word he reaches for are symptomatic of dementia or cancer or some other something. As she is a nurse, I try to give her opinions some respect, but I'm sure you all know that family members can differ over what an elderly parent needs to do or not do. Thanks to your replies, I will be voting to go along with the Dr's. recommendation. Thank you for putting my mind at ease. Bless you all!
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