Is 76 too old for prostate cancer surgery?

Take care and good luck

Even with the advances of robotic surgery, radiation is easier and has an easier recovery period. Depending upon the stage and the aggressiveness of the tumor(s) I'd take the radiation option, even without the consideration of anesthesia. Preservation of those important functions sexual and urologic have greater chance with radiation, most particularly if it is MRI guided radiation.
I wouldn't take the advice, offhand or not, of a urologist but would listen closely to the medical oncologist, surgical oncologist and radiation oncologist. For an objective view, you really need consultations with all three.

This is so crazy about PCa. Here you presented a case of PSA 1.2 with cancer, albeit only one of 12 cores.
My biopsy is done in Feb, 2024 and all 26 cores of them are benign. But my PSA is now up to 7.5. My next PSA and MRI are scheduled in August, 2024. I am almost sure of my destiny. I am bracing for impact.

Bobv48, looks like you have received a lot of great advice. For myself, If you are in good health with no other life limiting issues, I am an advocate for addressing the prostate cancer versus letting it grow and potentially metastasize. I was 55 when I was diagnosed with PC (Gleason 4/3), was in excellent physical shape, no other comorbidities, and had an want for 30+ additional years of cancer free life. I did all the research to ensure I picked a center of excellence (Mayo-Rochester), and went with a robotically assisted radical prostatectomy. I am 1.5 years out from surgery and all looks good thus far --> PSA undetectable, fully continent, and erectile function back.

In my opinion, age is a number, and you should make a decision on your personal physical and emotional health. If I were in good shape at the age of 72, I personally would want 20 more years of cancer free life, thus active surveillance or watchfully waiting for the cancer to grow and possibly metastasize would be off the table. However, if I had other comorbidities, this decision would obviously change.

In my opinion, the biggest advantage of surgery is removal of all known cancer and having the ability to perform a post surgery pathology to define margins & evaluate the cancer more thoroughly. Other treatment plans rely on imperfect imaging and biopsies to guide the treatment. I have personal family history (uncle) and read about far too many men who went with a less invasive treatment plan and lived to regret it. For myself, life was my #1-need, with a high want for continence, and a far lower want for erectile function. In the end, the only treatment plan that made sense for my personal situation was the radical prostatectomy at a center of excellence (with the best surgeon I could find). From what I have seen, men that do not utilize a center of excellence are at a far higher risk of incontinence, impotence, or other complications.

As always, the above comments are my personal experiences. Each man has to decide for himself what treatment best fits his wants/needs. In the end, we need to be confident in our treatment decision and live with the consequences.

Good luck on your decision and hope all goes well.

Jim

Tuckerp:
Clearly, your Father's history impacted your decision making.
And you wanted that cancer removed.
Completely understandable and entirely your decision.
You are a good role model; you investigated, tested and screened; considered the input and made a decision.
That is all any of us can do.
Best to you and everyone.

I am sure someone with similar results can help rest your mind. I have a friend who has a 9.0 PSA and they are still monitoring his. I do not know what his biopsy scores were. If you had 26 samples seems it would have been hard to miss a spot. Your doing the right thing by continuing to watch it. As I have told others , I am not the one to take advice from. I over reacted to the word cancer and removed it. I thought about radiation but Dr told me it was not likely to be removed after with any nerve sparring.

No, 76 is not too old! I just turned 78 and two weeks ago I had the Da Vinci Robot Assisted Radical Prostatectomy (RARP), with nerve-sparing, no lymph nodes removed. Surgeon had done 3500 RARPs and warned me that due to my age, my chances of full continence recovery drops from normal 85% to 65% and ED would similarly be more difficult. My regular urologist, had done 100, and graciously gave a referral to his more experienced colleague in their organization. I took to heart the recommendation here in this forum and in Dr Walsh's book to chose a surgeon who has done more than 1000.

Thankfully, the pathology report showed all margins negative, no cribriform, no intraductal, no extraprostatic extension, no seminal vesicle invasion.

Catheter was removed one week ago and wasn't nearly as difficult as I expected. My incontinence is improving day by day, currently at 3 pads per day with no leakage at night. ED is real and very strange but not a priority for me. I am restarting Kegels slowly because it still hurts when I do them.

Background:
Good health, mildly active- not a Mick Jagger, but I walk 2 miles most days. I have a spare tire I could probably lose 5 or 10# (BMI 23).

Had PSA of 5.9 and increasingly bothersome BPH symptoms. Had 2 MRI's, ExoDX urine test, PSMA-Pet Scan, Bone Scan, a cytoscopy, and a TRUS biopsy. Clinical T1c with Intermediate Favorable Risk GG2 (3+4=7) with 4 out of 12 cores positive. Had a genetic test (GPS) on the biopsy tissue with score of 47 indicated Active Surveillance may not be a smart option. I saw a Radiation Oncologist and second urologist before deciding on RARP.

In 6 weeks hopefully my PSA will be undetectable, then only PSA monitoring will be needed for rest of my life. If PSA is detectable and increases there are multiple avenues of treatment available so my statistical chances of surviving 15 years without dying of prostate cancer is 99% (MSK nomogram).

I wouldn't hesitate to do it again. Now I know, unequivocally, that the primary tumor no longer resides in my body. I feel like a dark cloud has been lifted after almost a year of wrestling with this complex decision making process and gnawing on it and stewing over the various test results and options.

I hope my story is helpful for you, my brethren, on your journeys.

"Life altering" is right. Best wishes for you.

Last year at age 77, I was offered the option of surgery. I chose radiation.
12 months post treatment my PSA is 0.23 and I have no incontinence and I have no issues with impotence.
I had 2 cores positive one was Gleason 4+3 Decipher intermediate unfavorable.
Diagnosis included PSA 7.5, MRI Sshowed 2 locations, biopsy 13 cores, PSMA PET. No spread outside of prostate.
Relieved a referral to MAYO and Radiation was recommended along with a 4 month course of ADT.
I did experience fatigue after treatment. One period of rectal bleeding that resolved on it's own.
I did experience loss of muscle mass and developed back pain related to a disc rupture. Recovering from the herniated disc was the biggest chall
enge i faced.
Before treatment I consulted with my primary care doctor, a urologist, a cardiologist and my VA primary care doctor.
I spoke with several people who had either surgery or radiation
The best resource I found was the Prostate Cancer Research Institute. Getting educated was very helpful and greatly reduced my anxiety.
I also found a local oncologist after my treatment who provides care management and he became an excellent resource.
A year out I'm very active, play music, bicycle, swim and do strength training twice a week
So. My advice to you.
Don't rush. Get good second opinions, learn as much as you can and talk to people who have received treatment.
Look beyond treatment and examine your life and goals. Treatment Cancer as a challenge, not a sentence.
Good luck to you

"bobv48" here's my short story:
I was 75 in 2021 and decided RALP the best route for these reasons.
Biopsy showed a region of aggressive PC near the margin, removal would be sure to get it out, surgery gives a definite read on the PC type and size, you know what is at or beyond the margins (mine was beyond), I had/have a fantastic surgeon/oncologist, and all other options are still available to me. I did have ADT of Lupron for 2-years and my PSA is negligible so I'm free of treatment save for twice a year PSA test at the same clinic/doctor's office. All my other side effects are manageable and I live my life to the fullest.
May your journey let you continue living to your fullest.
Blessings and prayers to you and all our brothers.