Anyone had a prostatectomy after age 70? Recommended or not?

I had RALP in my 70s last year. I had a catheter for seven days, which was inconvenient but very manageable, and I recovered from the surgery with zero complications.

I chose surgery over radiation primarily because I already had significant urinary symptoms related to BPH, and after discussing both options with my doctors, I was concerned that radiation could potentially exacerbate those pre-existing urinary problems.

I definitely won't be laying around after surgery I have 2 healthy golden
retrievers to exercise every day and currently walk 10 miles daily and
weight train 5 days per week been doing that for 45 years, obviously I
can't do that after surgery but will see how it goes. I just will use
elastic bands for exercise instead of weights for 4-6 weeks. Thanks

When a choice is mentioned it needs to be more detailed. Radiation has three plus flavors. External Beam Radiation [EBRT] which can be done in as little as 5-7 visits over several weeks, (SBRT), fewer visits higher dose. IMRT can be 20 visits (moderate) or 30-40 visits (conventional). They are sub grouped into standard gamma or proton radiation. Flavor Two is Internal Radiation (interstitial radiation) with 2 subtypes HIGH dose brachytherapy (HDR-BT) and the confusingly named LOW dose brachytherapy (LDR-BT). (a/k/a permanent seeds) Actually of all the listed forms the the optimal radiation dose is LDR-BT. Titanium seeds carrying an isotope decay over weeks to several months. The radiation is limited to the prostate within half an inch of the area to be treated. EBRT varieties are suboptimal doses because the beams converge only after passing through normal tissue outside the prostate. The dose is limited due to a variety of possible short term and long possible side-effects. ( Some risk assessment of the External beam gamma flavors can be determined with the UCLA derived ProsTox test (Miradx Co. ) Surgery or EBRT radiotherapy have about the same cure effect at ten years;
"however LDR-BT has about twice that cure rate." Check the pcri.org You-Tube videos on that last point. The 2025 ASCO Poster 388 is discussed along with the long term observation from a Kaiser Permanente record review by a Dr. GOY. Mentioned also was his meta analyses of high quality studies underpinning that conclusion.

The third flavor of radiation is provided systemically by radioligands. Small toxic doses are attached to a molecule that zeroes in on cancer cells. It is now available for select metastatic disease that remain sensitive to hormone deprivation.

I am 75 and had RALP 9 weeks ago. The surgery went well and my recovery seems to be pretty normal. The first two weeks after surgery were a bit of a challenge — dealing with a catheter for 1 week was no fun — but manageable. I still have incontinence but it’s improving. I use about 2-3 pads a day and pull-ups at night, which isn’t ideal but is manageable and, as I said, is getting better. I haven’t had PT yet, but take my pelvic floor exercises seriously. I started playing golf again after 5 weeks and at 6 weeks took a 3-week trip to Italy, returning last night. I was in good shape before the surgery and, in sum, don’t think my age has had any appreciable impact on my recovery.

I was 71 when, after considering options, I chose RP. I did Kegels religiously before and after my surgery. I had some serious pain immediately after waking up but that went away quickly. I had Zero incontinence issues. My surgeon said I was one of the lucky 10%. Another thing that my surgeon told me prior to surgery was that he was looking forward to operating on me because I have very low body fat. I have exercised regularly for over 50years.

One thing that you didn’t mention was any testing scores: PSA, Gleason score, Decipher if given, etc. These could influence his decision. My biopsy score came back at 3+4. After the surgery the pathology report came back at 4+5. I also had a post procedure decipher score that was high. Since that time I have had undetectable PSA. I go in for my next blood test next week. Hope and pray for more of the same. I mention my story so your brother in-law can consider all factors in determining his next step. Best wishes👍🙏

I appreciate the positive feedback...thanks so much!

I had the procedure at 71 and was assured that it was contained. However, nine years later the cancer had metastasized and treated with ADT. At this time I'm off Ogoviyx and just on Nubeca and PSA .02 for two months. I recommend doing PSA' tests periodically after a procedure over time.

Yes, two years ago, at 78, I chose surgery. Below is a link to my previous answer to a similar question under the topic "Is 76 years old too old for surgery".
Since I made that Comment, and as an octogenarian, I still am confident that, for me, surgery was the right decision. Best wishes to you and congratulations on finding this forum. The brethren were a big help to me (Thanks y'all!)
https://connect.mayoclinic.org/comment/1075893/

I had RALP over 5 years ago at age 74.5 I was CR, Gleason 9, incurable and locally metastasized. My PSA has been undetectable since surgery, no meaningful side effect and hoping for as much time as possible. I followed my UCLA urologist’s advise and glad that I did.

@jimcarr .I am in Australia ,had Total Prostatectomy at 75,5 years on it is .26 slowly going up by about .4 p.a. but not yet at the "doubling" when here in Australia they start the radical treatments ,Now nearly 81 and "fit as a fiddle"

bob Jordan
Queensland