I'm 82 years old and did an MRI, Biopsy and PET Scan with very minor inconveniences. I'm now being treated for metastatic prostate cancer by two means. They are Camcevi 42 mg subcutaneously every 6 months and Xtandi four 40mg pills taken daily. This is not a cure, but the treatment is very tolerable, and I feel good about my life being prolonged.

liangnil, I am 76. His PSA was way to high. It should have been addressed when it got above 4.

The first step, at least in my case, was a MRI. The MRI will show suspicious areas or not. There is no pain or discomfort from this test. From that test a decision to do a biopsy or not can be made based on MRI results and your brother's wishes.

A urologist can give your brother as well as radiologist/oncologist the available treatments for prostrate cancer. But is usually based on biopsy results. There are hormonal and medication that can slow/stop the growth of prostrate cancer but can have serious side affects. They could be minor or serious depending on his reaction to them.

Is he in a nursing home now? I am not sure who said painful treatments to him. Radiation treatments are pain free. They affect the cells of all prostrate cells and damage all. The regular cells can repair themselves but cancer cells ability to repair is damage so they cannot. This is the treatment via radiation as cancer cells will die off and not grow/repair themselves. There are also other tests like PSMA, bone, etc. that can tell your doctor and brother whether cancer is limited to prostrate or spread. The treatments are very different if spread to outside of prostrate. There is also a test called Decipher that uses the taken biopsies to determine if low risk, intermediate risk, and high risks of metassing outside of prostrate. That too also can determine type of treatments. I had radiation only and had no pain during any procedure and treatments. I did have some reduced urine flow that went away with time. That is why I asked about any symptoms now.

At his age I think no urologist would recommend surgery. That would be the most invasive and painful symptoms recovery. I guess my suggestion (please remember none of us are urologist, radiologist, oncologist so just suggestions from those who have been treated) would be to have a MRI to see. Is your brother in good shape except for this? If so a different outlook.

There is no real time line for life expectancy. He could live another 10 or more years or less. Most urologist say if prostrate cancer is confined to prostrate you will probably die from something else if you are at an advanced age like his. But is his cancer only in his prostrate? That would most likely change that if it has spread.

Just understand that medication and hormone treatments can have some real side affects versus radiation treatments are usually minor. Does your brother have an prostrate symptoms now other than high PSA? I am not sure but maybe reluctant to discuss with you if he does.

The reply by jc76 was excellent . I am 77 will be doing SBRT radiation in 6 weeks. Can't believe his doctor waited this long, with a high PSA. radiation is not normally painful. Best wishes

My last PSA was 25
I'm 88 My new Doctor (Urologist)think I should have a Biopsy
I spoke with my Doctors (Urologist) who have treated me for the past 10 years for Blatter
cancer so far very good They are both aware of my PSA almost doubled in past 10 years
Because of my age they don't advise the Biopsy
What is your opinion
John

Please tell your brother to consider a biopsy, my psa was a 21 ten years ago, got a biopsy, and then had radiation seed therapy, my psa stayed below a 5, for those 10years, of his psa is at a 20, most likely it's prostate cancer. But ghe good news if he gets the radiation therapy, or now you can get hormone therapy to bring his psa numbers down. But doing nothing isn't the way. The psa numbers don't go down by themselves, we must have some kind of intervention, from modern medicine. I hope this helps, good luck on talking to your brother.