Time for a biopsy?

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Rolerbe
Regular Member


Date Joined Dec 2008
Total Posts : 235
   Posted 2/17/2011 10:32 AM (GMT -6)   
My 78 y.o. father has been 'watchful waiting'.  He called last night with the results of his latest PSA.  Which has been slowly but steadily rising.  Up to 8.5 from 8.0 about a year ago.  GP says time to talk to Urologist (with the intention, I'm sure of getting a biopsy).
 
He's pretty resistant to biopsy (I may have tainted him some with 'colorful' stories of my own ordeal). 
 
At his age and current PSA / velocity, how critical do you think it is to get Gleason type information to make decisions?  Other thoughts?
 
Edit - I should add that he's a 'young' 78 -- i.e. still pretty active and able.  Last year he was one of my three man crew for a sailing trip around the Delaware-Maryland-Virginia (DelMarVa) peninsula with ovenight watches on the ocean side, etc.  Pretty good, I think, at that age.
 
 

Post Edited (Rolerbe) : 2/17/2011 9:49:27 AM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/17/2011 10:50 AM (GMT -6)   
That's a tough call at 78. If it were me, and assuming I was in pretty good medical shape at that age, I would want to a biopsy done just to rule PC in or out. If there were PC, then due to age, and status of biopsy, treatment choices if needed might be more limited.

How is he healthwise other wise?

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

p_elliott
Regular Member


Date Joined Nov 2010
Total Posts : 143
   Posted 2/17/2011 11:04 AM (GMT -6)   
Not sure there is point at his age, PC is a slow growing cancer. He can if he wishes but I'm not sure they will do anything if they find it.

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 2/17/2011 11:08 AM (GMT -6)   
If memory serves me, I thought that the threshold was 0.75 rise in 12 months was the trigger point for further investigation. But that may have been an old figure....so much has changed just in the last couple of years it's hard to keep up.

Good luck
You are beating back cancer, so hold your head up with dignity

Les

Robotic Surgery Sept 2008
PSA increasing since January 2009
Current PSA .44 (29 months)
PSA Doubling time approx. 6 months
Clinical Trial - SRT begins 2/21/11

Rolerbe
Regular Member


Date Joined Dec 2008
Total Posts : 235
   Posted 2/17/2011 11:59 AM (GMT -6)   
I agree it's a tough call. His health, apart from CABG (quadruple bypass) and a series of Stent's is pretty good. Could probably use a knee replace in one, but he gets Cortisone shots every 6 mos or so which help out.

I guess I would lean towards doing the biopsy. If Gleason 7 or above, then maybe seeds. From JAMA 1998; 280 and article called "Competing Risk Analysis of Men Aged 55 to 74 Years at Diagnosis Managed Conservatively for Clinically Localized Prostate Cancer", the 15 year mortality risk for 70-74 yo's, specific to PCa, was about 40%, and about equal to the risk from all other causes. That's still a lot of area under the curve.

"Managed Conservatively" meant no surgery or radiation of any form, but harmone therapies for some of the patients at some point in the progression.
age 52
RALP 10/08
One nerve spared
Gleason 7 - T1c
Pre op PSA 8.2 -- first PSA ever taken at age 50 physical
Most recent PSA 0.02 (12/10)

Post Edited (Rolerbe) : 2/17/2011 11:02:39 AM (GMT-7)


John T
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Date Joined Nov 2008
Total Posts : 4229
   Posted 2/17/2011 12:00 PM (GMT -6)   
At 78 why bother. It will just create more stress for him. The 10 year survival rate for PC with a low psa is near 100% so he will most likely never die of PC whether treated or not.
JohnT
65 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, no side affects and psa .1 at 1.5 years.

Rolerbe
Regular Member


Date Joined Dec 2008
Total Posts : 235
   Posted 2/17/2011 12:05 PM (GMT -6)   
Here's a link to the article I cited:  http://jama.ama-assn.org/content/280/11/975.full.pdf
 
John,  you may be right.  Hard for me to tell whose demons I'd be chasing, his, or my own.
age 52
RALP 10/08
One nerve spared
Gleason 7 - T1c
Pre op PSA 8.2 -- first PSA ever taken at age 50 physical
Most recent PSA 0.02 (12/10)

Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 2/17/2011 12:17 PM (GMT -6)   
John T said...
At 78 why bother. It will just create more stress for him. The 10 year survival rate for PC with a low psa is near 100% so he will most likely never die of PC whether treated or not.
JohnT


I agree 100%

mjluke
Regular Member


Date Joined Jan 2009
Total Posts : 189
   Posted 2/17/2011 12:58 PM (GMT -6)   

Totally agree-the side-effects and decline in quality of life will make him regret the day he ever agreed to a biopsy and subsequent treatment- whether surgery, radiation or any other. Given his age it is highly unlikely that he will die from prostate cancer in my opinion.

Don't do it.


 
63 years old-tumor discovered on digital exam- biopsy December 2008-
4 of 12 samples positive-all on right side
Gleason 3+3=6
PSA-3
Otherwise excellent health.
Brachytherapy- May 19, 2009 -so far, so good.
 
  "There may come a day when the courage of men will fail, but it will not be this day."

Trepidation
Regular Member


Date Joined Feb 2011
Total Posts : 173
   Posted 2/17/2011 3:39 PM (GMT -6)   
Maybe having a PSA test every 3 months would help in estabilishing an accurate doubling time. Mr. John T may be onto something IMO.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/17/2011 4:18 PM (GMT -6)   
JohnT, that sounded cold in your last post. The man might be 78, but sounds in good health, he may live to be a 100, another 22 years from now. He may have PC, and it may be treatable in a way that makes sense to his age/health. It may have some bad PC, and knowing about it is not a bad thing. Might still be able to help him, or suffer less in the future. I believe every life is equally important, and I am not going to write someone off because they are 78. Thought we strongly believed in testing around here, and what happened to "not knowing" is not good medical advice?

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Rolerbe
Regular Member


Date Joined Dec 2008
Total Posts : 235
   Posted 2/17/2011 4:48 PM (GMT -6)   
It is a question of relative risks. John has said that the 10 year survival rate for psa in this range is near 100%. Any other references than the one from 1998 I linked in? In that, the 10 year mortality due to PCa was reported to be:

                10yr          15yr (10 yr #'s are approx, taken from the graphs)
GS 2-4:      5%            7%
GS 5:         8%          11%
GS 6:       21%         30%
GS 7:       32%         42%
GS 8-10:  55%         60%

I also just took an extract from the Yananow site for psa's from 8.0 - 9.0. 32 subjects. GS min = 6, max = 8, mean was about 6.7. Not truly 'science', but not just numerology either.

Would greatly appreciate any other predictive references. If the risk is low, then do nothing now is right. If its 30%, then treatment may be warranted.
age 52
RALP 10/08
One nerve spared
Gleason 7 - T1c
Pre op PSA 8.2 -- first PSA ever taken at age 50 physical
Most recent PSA 0.02 (12/10)

Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 2/17/2011 5:00 PM (GMT -6)   
Rolerebe.

If your dad is "pretty resistant" to a biopsy at his age(and I don't blame him) why are you pressuring him to maybe have one. ? His quality of life appears to be fine why would you want him to possibly suffer possible radical treatments, incontinence, months of pads or maybe a lifetime of them. He's 78 for gods sake let him make his own decision. The modest gain in PSA at his age wouldn't be a cause for my concern if it was my dad. Not at all.

The chart you bring from 1998 is really ancient as far as studies go. I'm sure someone else will link to to a much newer and more optimistic realistic 21st century graph

Dave he may be 78 and he could live to be 100 but most likely he won't. Even if he does I still bet something else will end his life before PCa. He's 78 not 58
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A

2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study

4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal

7/30/08 - Psa: .32
11/10/08 - Psa.62 -
April 2009 12 of 12 Negative Biopsy

2/16/10 12 of 12 Negative Biopsy

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3748
   Posted 2/17/2011 5:41 PM (GMT -6)   
Ask your docs THIS question..Should the biopsy find cancer, what, if any, treatment would they recommend??

Perhaps having a DRE and then putting him on Avodart (HT Light) for a while makes more sense..You can FORGET surgery and radiation is getting pretty risky on the old, fragile tissue....The biopsy itself could kill him...But visiting a urologist will not..
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

Rolerbe
Regular Member


Date Joined Dec 2008
Total Posts : 235
   Posted 2/17/2011 10:03 PM (GMT -6)   
Ziggy, I haven't actually been pressuring him at all, we've only had one conversation.  His 'resistance' is just the natural distaste when considering a procedure for the first time.  I'm not sure he should have it done either. 
 
I do think he should have a visit with a Uro to ask the essential question that Fairwind raised.  But I've found it best to do the research and go prepared.  So, I'm updating my info and gathering opinions to discuss intelligently.  Thanks to all for the replies.
age 52
RALP 10/08
One nerve spared
Gleason 7 - T1c
Pre op PSA 8.2 -- first PSA ever taken at age 50 physical
Most recent PSA 0.02 (12/10)
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