Radical treatment for older patients with prostate cancer?

Hi

I am a 5.5 year stage 2 bowel cancer survivor myself but am posting in relation to my father who is 85, otherwise very healthy, but has recently had two repeat PSA results at 7 ng/ml. He was referred from primary care to the local hospital in Doncaster for a 'one stop shop' assessment where my understanding was that he would have an mp-mri and, if subsequently necessary, biopsies taken. However, when I spoke to him afterwards, it transpired that he had had another DRE and the consultant/clinician had said he wasn't too worried and referred him for 3 monthly PSA monitoring. I was rather suprised that they didn't at least do the mp-mri which might possibly preclude the need for biopsies or, alternatively, pick up any cancer indicative of the need for biopsies. Having spoken to a consultant oncologist (specialising in prostate cancer) contact of mine, she has said that she would concur with the decision because she wouldn't want to subject an 85 year old to radiotherapy or radical prostatectomy so there would be no point in doing the mp-mri (i.e. if it picked up cancer it wouldn't be treated radically anyway). 

Whilst I know cancer treatment can be tough (from personal experience) I am still surprised that the option of potentially curative treatment, if cancer is found, is not at least given to the patient rather than them being left on monitoring with possible less radical life extending treatment (as opposed to curative) being given if the PSA continues to rise (by which point the cancer may have metastasized and be beyond cure presumabley).

I'd just be interested in hearing the patient's / relative's views on this scenario.

Any comments/advise welcome and I wish you all a pleasant festive season.

Thanks

EdP 

  • Hi EdP. Welcome to the forum.

    I am not a doctor and I have no medical qualifications. However I was diagnosed with prostate cancer 8 years ago when I was 56, and I had surgery to remove my prostate.

    It is known that many older men develop prostate cancer, but prostate cancer in older men is frequently slow growing and unlikely to be life-shortening. It is often said that such men more frequently die with prostate cancer rather than of prostate cancer. When evaluating an older patient, the consultant therefore has to balance the real possibility that the treatment may do more harm than good. The old adage of the cure being worse than the disease strongly applies in these situations. 

    A PSA of 7 isn't particularly high and monitoring every 3 months makes sense. If the PSA remains stable then the right thing to do is nothing at all.