Is 76 too old for prostate cancer surgery?

Posted by bobv48 @bobv48, May 25 11:35am

A urologist my brother asked regarding my wondering about surgery vs radiation said that no one 76 years old should get the surgery. Does this square with what anyone else may have heard?

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@bobv48

In my case, cancer detected at low level at age 75, put on active surveillance and this year it had grown slightly. Because it was growing, even though still low level, my urologist suggested either surgery or radiation. It was a second urologist who suggested that no one at age 76 should have the surgery, just the radiation. I will be meeting with both radiation oncologist and surgeon in the next few days and am seeking any advice from community that might inform my decision. I had originally been leaning toward surgery.

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that is a major surgery I was 68 when first diagnosed with a psa of 12.5 and metastatic because it was metastisized already they did not recomend surgery I had 26 rounds of radiation and 18 months of lupron with aberaterone and seeds placed in my prostate hurt like hell,18 months later I was 0.05 undetectable for another 18 months then started to tickup now on lupron and xtandi going for another pet scan. if I was you go with the radiation 15 minutes a day done.

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@ecurb

My radiation oncologist/medical oncologist say: at my age 75: you get the same results via surgery or radiation, so at my age I chose RT. 28 visits with ADT - now my PSA < .01. For a year now.

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Yes, in fact I think the 15 yr outcomes for surgery and Cyber-Knife are identical. So 15 yrs out, if you are still "cured" or if there is recurrence, it doesn't matter which option you chose. At age 76 that puts you at 91 yrs old - IF you live that long and don't die from something else first.
5 Visits of cyberknife treatments offer a lot fewer complications than does surgery, but ultimately it's your choice and you have to be comfortable with the decision. Best of luck!

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@heavyphil

Yes, in fact I think the 15 yr outcomes for surgery and Cyber-Knife are identical. So 15 yrs out, if you are still "cured" or if there is recurrence, it doesn't matter which option you chose. At age 76 that puts you at 91 yrs old - IF you live that long and don't die from something else first.
5 Visits of cyberknife treatments offer a lot fewer complications than does surgery, but ultimately it's your choice and you have to be comfortable with the decision. Best of luck!

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I m not sure what cyber knife treatment is...Radiation therapy?

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@heavyphil

Yes, in fact I think the 15 yr outcomes for surgery and Cyber-Knife are identical. So 15 yrs out, if you are still "cured" or if there is recurrence, it doesn't matter which option you chose. At age 76 that puts you at 91 yrs old - IF you live that long and don't die from something else first.
5 Visits of cyberknife treatments offer a lot fewer complications than does surgery, but ultimately it's your choice and you have to be comfortable with the decision. Best of luck!

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hmm. 15yr outcomes for surgery if no recurrence. Dang I selected surgery thinking it gave me unlimited yrs from prostate cancer. If I lived that long is the key word.

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Always good to evaluate all the options with prostate cancer. one treatment definitely does not meet the needs of all men. As a person ages into later years, I would personally would look more closely at non-invasive treatments. However, for myself (55 at time of diagnosis, now 57, excellent health, GS 4/3) I evaluated all the options and the treatment that best aligned with my main goal (30+ years of PC free life to live with wife, child, family, friends, etc.) was a robotically assisted radical prostatectomy at a center of excellence, with the best surgeon I could find (Mayo-Rochester and doctor Igor Frank).

Anyone that has journeyed down the prostate cancer path will tell you - No matter what treatment plan you decide on, cancer is tricky and there are no guarantees the cancer is gone forever. However, surgery was the only option that allowed for a physical pathology to be performed, a guarantee that there is no undetected cancer left in the prostate or seminal vesicles (they are now out of your body), and allowed for all other treatment options to be utilized if the PC returned.

There are risks with all treatment plans, and surgery definitely has risks - Incontinence, impotence/ED, infection. However, you can significantly reduce the chance of these risks (not eliminate) if you do your homework and utilize the best possible surgeon at a center of excellence. It is sad to see so many men who are unwilling to put in the upfront work, get a radical prostatectomy at a local low volume hospital, then spend the rest of their lives regretting their decision or complaining about unexpected consequences. If you decide on surgery, please please please do you homework and pick a center of excellence and the best doctor at that center of excellence. In most cases, you have the time to do the upfront homework and ensure you get the best possible treatment.

Best of luck to all,

Jim

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@hammer101

Always good to evaluate all the options with prostate cancer. one treatment definitely does not meet the needs of all men. As a person ages into later years, I would personally would look more closely at non-invasive treatments. However, for myself (55 at time of diagnosis, now 57, excellent health, GS 4/3) I evaluated all the options and the treatment that best aligned with my main goal (30+ years of PC free life to live with wife, child, family, friends, etc.) was a robotically assisted radical prostatectomy at a center of excellence, with the best surgeon I could find (Mayo-Rochester and doctor Igor Frank).

Anyone that has journeyed down the prostate cancer path will tell you - No matter what treatment plan you decide on, cancer is tricky and there are no guarantees the cancer is gone forever. However, surgery was the only option that allowed for a physical pathology to be performed, a guarantee that there is no undetected cancer left in the prostate or seminal vesicles (they are now out of your body), and allowed for all other treatment options to be utilized if the PC returned.

There are risks with all treatment plans, and surgery definitely has risks - Incontinence, impotence/ED, infection. However, you can significantly reduce the chance of these risks (not eliminate) if you do your homework and utilize the best possible surgeon at a center of excellence. It is sad to see so many men who are unwilling to put in the upfront work, get a radical prostatectomy at a local low volume hospital, then spend the rest of their lives regretting their decision or complaining about unexpected consequences. If you decide on surgery, please please please do you homework and pick a center of excellence and the best doctor at that center of excellence. In most cases, you have the time to do the upfront homework and ensure you get the best possible treatment.

Best of luck to all,

Jim

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can I ask if you regained both ED and INT. to what level?

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I was 75 when I had surgery. I was a Gleason 8. My thought process was : if it’s in you get it out.

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@ecurb

I m not sure what cyber knife treatment is...Radiation therapy?

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Yes, it’s a 5 session radiation therapy - as opposed to the 27 to 30 odd treatments many men receive.

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All good advice above. Trust it but put in your own research and doc's guidance above all.
BTW, I just remembered one tiny step I took before going to the hospital for RALP.
I showered just before leaving but used Hibiclens from knees to nipples as far around as I could reach. Then I put on just sweat pants that had been washed in a mild chlorine bleach wash.
Maybe it did no actual good but it kept me part of the pre-op procedure and a feeling I'd done all I could to avoid infection risk.
Good luck and get your mind set on a positive direction to do all you can to whip the PC with successful treatment.

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Hello to all of my fellow men dealing with Prostate Cancer. I was diagnosed at age 68 with PC. After doing a lot of research and consulting with a number of physicians, specialists and others etc. Evaluating the pros and cons of surgery vs radiation. I chose to have the RALP procedure performed.
As there is NO single best treatment therapy, the treatment therapy that’s best for you will usually reveal itself to you if you do enough research and become as knowledgeable about your particular case of PC as you can.
One’s overall health condition(s) along with their personal risk attitudes, general and specific preferences and ultimately, their “gut feelings,” will usually reveal the best path forward regarding your ultimate choice of treatment.
Regardless of the methodologies of treatments you pursue, PC will create a multitude of challenges to deal with physically, mentally and emotionally!
Ultimately, I chose the surgical route because my cancer had not metastasized and my surgeon was confident that he could remove 100% of the detectable cancer. It’s been 19 months since my surgery and my PSA has remained constant at < 0.014 since the day after my surgery. I was on “TRT,” TESTOSTERONE REPLACEMENT THERAPY for 13 years before my PC was diagnosed. I had to discontinue my “TRT” for a total of 5 months before, during and after my surgery before I could resume it again.
I felt absolutely terrible during those 5 months as my Total Testosterone was between 20-90. Essentially, I was already medically castrated without even being on Lupron or other related drug therapies.
I have also been severely debilitated from CFS, CHRONIC FATIGUE SYNDROME, FIBROMYALGIA, (FM) and the effects of CHIARI MALFORMATION, (CM), for the past 33 years! I was able to have neck, head and brain surgery 23 years ago to address the CM. Unfortunately, there are no recognized or proven treatment protocols to effectively and measurably address CFS and FM. In short, NO effective or long term cures have been discovered yet!
I share this personal information with all of you as an example of how ones’s current overall health condition(s) can greatly influence their ultimate decision to initially utilize the surgical or radiation route.
There’s absolutely no way I could effectively function in my life with all of the above and utilize the radiation and Lupron treatments.
When I resumed my “TRT” my overall health, energy and stamina improved dramatically for the best.
Also of great importance to me was to have the option of utilizing radiation therapy if my cancer ever returned. Most physicians will advise that having the surgery first provides you the opportunity to utilize the radiation at a later time if needed. However, if you choose the radiation therapy first and your cancer returns, most surgeons are very reluctant to do the salvage surgery due to all of the dead and damaged tissue present from the previous radiation treatments. Personally, I felt it advantageous to have a better 2nd option choice available if I ever need it.
My quality of life is actually absent of any meaningful quality of life without my “TRT.” I merely exist and remain in a very debilitated state, mostly home confined and bedridden.
There had been a long held belief that utilizing “TRT” after surgery would significantly increase the chances of a Biological Recurrence of a patient’s PC. However, based upon the latest and most current research plus numerous patient studies along with actual scientific facts and results has proven that the previously outdated and extremely limited research, (which wasn’t even based upon actual patient studies but extracted from studies done on rats), has “debunked” this previously outdated opinion and belief. This was an extremely limited opinion expressed by only 2 physicians back in the 1940’s and has been proven to be no longer relevant. It’s true that Testosterone will feed and fuel the growth of PC if it’s still active and present in your body. However, if the PSA factory, (your Prostate) is removed and there is no more detectable cancer in your body. Then there are no more cancer cells for the Testosterone to feed or fuel. Essentially, you’re now in the same state and position as a man who has never had PC. If “TRT” is assumed to be safe and continues to be given to many men who have never had PC or developed it. How can you deny a PC patient who post surgically no longer has any PC in his body that it’s somehow not safe for him to utilize “TRT?”
Of course, there is always the chance that some of the cancer cells escaped during the surgery or previously to it even though there was no detectable cancer present which was verified by the surgical labs. Statistics state that there is about a 30% chance of one’s PC returning after the first 5 years following a successful surgery even without being on “TRT!” Utilizing the much more current research plus significantly more actual patient studies, (cohorts), many surgeons are now recommending to their surgical patients to utilize “TRT” to
provide them with increased benefits and the quality of their post surgical recovery.
Regardless, one has to do sufficient enough research on the subject to determine if this treatment is appropriate for them or not.
As I had previously mentioned, I had already utilized “TRT” for 13 years prior to my surgery out of necessity due to my severe case of Hypogonadism which had caused a severe drop in my levels of Total Testosterone. The fact remains that having and maintaining sufficient overall levels of Total Testosterone in your body is essential to maintain overall good health, well-being and other important contributing physical and mental factors
In closing, I hope that some of what I’ve shared about my own personal health history and the choices I made regarding the initial and ongoing treatment for my PC and overall wellbeing will be of some value and assistance to other PC patients.
I wish you all the very best in your continuing journey and lifestyle challenges that present themselves to us all.
GODSPEED,
Phil

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