Is 76 too old for prostate cancer surgery?

Posted by bobv48 @bobv48, May 25, 2024

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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@thmssllvn

Patrick Walsh MD the father of Robotic Surgery once said that he would not do prostate surgery on a man over 70 unless he brought his parents in too.

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I had successful RP at 72 at Johns Hopkins, where Dr Walsh practiced.
I had a 2d opinion mtg with a JH surgeon and he initially suggested that I was too old for surgery.
I advised him that both parents lived to 95, that I had no commorbidities and I wanted my G 9 cancerous prostate removed.
And he agreed.

So in a way, I brought my parents to the consult.

RP was the right choice for me. And I had "persistent" PSA .19 post-op, which took me directly to Salvage Radiation w/ 4 mos ADT.
My PSA has been undetectable < .02 past 18 mos. Now 75 w/ testing end of May.
However, surgery is not the only or right choice for others.
Best wishes.

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I was on Erleada and lupron for 6 months before surgery and then 6 months after surgery and then the meds were discontinued. My doctor has advised that when the cancer returns I may then have radiation and Erleada and lupron again I am 3 years past the surgery and meds routine and certainly hope that I will remain undetectable cancer Good luck to all!

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Re: Bringing parents to urological surgeon's visit if over 70. Zeke Emanuel MD said maybe 75 is the best time to check out of the hotel as everything seems to go south after 75. Having reached that age he has altered his view
if one is otherwise healthy. My father at 88 had an aortic valve replaced and a triple bypass. He lived until 95. But he had only 6 months to live at 88 without the surgery.

Prostate cancer treatments and prognoses are changing. Multiparametric MRI, PSMA PET/CT scans, urine (MPS 2.0) & pathologic slide genomic tests (Decipher, etc.) as well as AI pathology (Arterra) have affected all
on the non-metastatic disease spectrum. The longevity of one's parents is a factor in choosing a treatment. Now there is Pluvicto and spot RT for oligomets. Scientific studies, cognizant that they have not incorporated the latest information by several years to a decade, should inform the quality of life side effect analysis. The 'quick fix' idea of surgery does have marketing appeal, It appears that many on the non-metatstatic spectrum have non-inferior results with a radiotherapy hormonal approach.

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@thmssllvn

Re: Bringing parents to urological surgeon's visit if over 70. Zeke Emanuel MD said maybe 75 is the best time to check out of the hotel as everything seems to go south after 75. Having reached that age he has altered his view
if one is otherwise healthy. My father at 88 had an aortic valve replaced and a triple bypass. He lived until 95. But he had only 6 months to live at 88 without the surgery.

Prostate cancer treatments and prognoses are changing. Multiparametric MRI, PSMA PET/CT scans, urine (MPS 2.0) & pathologic slide genomic tests (Decipher, etc.) as well as AI pathology (Arterra) have affected all
on the non-metastatic disease spectrum. The longevity of one's parents is a factor in choosing a treatment. Now there is Pluvicto and spot RT for oligomets. Scientific studies, cognizant that they have not incorporated the latest information by several years to a decade, should inform the quality of life side effect analysis. The 'quick fix' idea of surgery does have marketing appeal, It appears that many on the non-metatstatic spectrum have non-inferior results with a radiotherapy hormonal approach.

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That is all true unless you have cribriform and IDC type of PC. Very aggressive elements in those cases require more definite approach. Cribriform cells show very high level of genetic changes and sometimes can even evade radiation (as per some cases I saw on other sites).

Surgery is not a "quick fix", nothing is in PC.

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FWIW, I was 78 and in good health when diagnosed. My urologist at a renowned cancer center strongly recommended against surgery, saying that it is recommended if one has an expected life of 20 years thereafter, and age 98 seemed a a stretch. He said radiation was the standard of care and that I was highly likely to have a great outcome. So that's what I did.

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