I am 83 years old with a PSA of 6.5. Will have a prostate biopsy soon.
Would be interested to know what kind of treatment options I have available, depending of course on the biopsy results. I am in reasonable good health, with high blood pressure being treated. How limited are my options based on my age of 83?
Interested in more discussions like this? Go to the Prostate Cancer Support Group.
I am 77 my PSA numbers have been very high for years and two years ago had my first MRI and biopsy which turned out to negative for cancer. The number continued to climb and this year had my second MRI which this time showed a very small area of concern. This time I was offered an ultrasound guided biopsy which I agreed to. My results were 6 samples were negative for cancer and 6 were 4+4 for Gleason score of 8 positive for cancer. If your MRI shows any concern I highly recommend having an ultrasound guided biopsy. My Doctor has me on Orgovyx for two years and will start radiation treatment in September. Since I am a Vietnam Vet and the VA considers exposure to agent orange as presumptive to prostate cancer I am receiving 100% disability from VA through out my treatment and for six months afterwards.
Hi. I was thinking Orgovyx, but yes, have been reading good reports about Nubeqa here on the Mayo site. That will be my first choice on the 30th.
As mentioned earlier, I think, I only see a urologist and when I asked about an oncologist, was told that one would have to be taking chemo or radiation treatment; ADT doesn't qualify. So there you have it.
Anyway, I appreciate everything you have told me.
Thanks, again!
Mick
85 here with zero health issues except PC. Last year (Jan 2024) PSA was 12.3 so I was referred to a urologist. 10 months later I finally got an MRI showing 2 lesions (PIRADS 5). Subsequent biopsy revealed Gleason 4 + 5. Nothing in lymph nodes however there is cribriform plus cancer in one side seminal vessel. Bone and full CT scans clear so it appears to be localized advanced (high risk) PC. No PSMA scan. Four months done with ADT (Eligard). Started 20 fractions of EBRT radiation. It seemed like the RO was trying to talk me out of doing radiation because of the side effects, my age, and quality of life issues. I too would like to be around for 15 more years (God willing). Seemed to me that not killing an aggressive cancer was not a good idea. Anyway, I may regret it but I'm in for ADT and Radiation.
First of all, congratulations on being 83, and being 83 with only a 6.5 PSA. That is cause for biopsy for sure, but too much is unknown yet without the biopsy results. My example shows that whatever you get from the biopsy is potentially "half" the story:
I am 70 years old. I did not have a PSA for four years because my personal physician packed up and moved his practice without telling his patients ("yep"). I just focused on my Type 2 Diabetes care and let four years slip away before I told my new Internist that I needed a PSA. It was 6.1. Next step was having the "Exosome" urine biomarker test. Anything less than a score of 15 was good. My score was 52 - not good. So, next step was the biopsy. I had the usual 12 core samples taken. Three were normal/negative, three were Gleason 6, and six were Gleason 3+4=7, with only 10% being "4". I also had "perineurial invasion" which is quite common, but still not good. Besides saying that "it is good we caught this early", my Urologist also said that "surgery is the only option...why wait and monitor for two years, when all you are doing is giving the cancer a chance to grow, perhaps to a point of no return?" So...
I had my prostate removed in mid-April. Then came the "other half" - the important stuff - from the surgical pathology report: I had slight invasion of the left seminal vesicle (both seminal vesicles and both Vas Deferens were removed with the prostate). But, I also was one of the unlucky 10-20% that had "surgical margins", meaning my doctor did not "get all of the cancerous tissue" out of me. I also had "Cribriform" pattern cells and Extra-Prostatic Extension ("EPE"). No biopsy can or will reveal EPE, Cribriform pattern, or seminal vesicle invasion. That all comes "after" your radical prostatectomy. Going into my surgery, my Urologist touted the single-incision, DaVinci Robotic-Assisted Radical Prostatectomy as being the best, with only a 3% recurrence rate of cancer thereafter. But...
In my first post-surgical appointment 11 days later to have my catheter removed, as we were parting company - appointment over - he casually said: "We're going to have to talk about radiation next visit because your cancer is kind of aggressive." Then he was out the door...his timing was purposeful...I feel that he said it as he was walking out of the room because he didn't want to get into a long discussion (I ask lots of questions). I think he felt bad that I was in that 10-20% group with "surgical margins"...it was a reflection on his less-than-perfect surgical expertise.
So, I have gone from a secure and confident guy with a Gleason 3+4 = 7 with only 10% being "4" on biopsy, with my Urologist joking that I'll be around no less than 15 years from now, to a completely confused, doubting patient who still has to have that second appointment and discussion of radiation to kill the tissue that my surgeon left behind, and with the possibility of only a 5-10 year lifespan based on the pT3b category that the seminal vesicle invasion put me in. Apparently, even after prostatectomy and radiation, pT3b cancer tends to just "come back" at around five years...I guess with monitoring of your PSA 3-4 times yearly.
So, with apology for the long story, keep an open mind...don't worry about what you don't know, but understand that with a 6.5 PSA, your biopsy results will likely show some degree of cancer, with your best option being surgery. Good luck, and again...congratulations on already achieving 83 years of age and only now having the 6.5 PSA. That usually happens more at my age of 70 - 75.
I was diagnosed with Gleason 9 PC on March 5, 2024 when I was 88. I went through 5 sessions of SBRT and 12 months Orgovyx. I think radiation and ADT is necessary in your case as it was in my case.
Good Luck