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85 year old due for biopsy

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Posted 6/6/2018 3:01 PM (GMT -5)
I am 85 years old but in relatively good shape. Recently I had my psa checked. It came back 7.4. Saw uro at Geisinger urology clinic in Danville, PA who informed me my psa was probably twice that because I'd been taking finesteride for an enlarged prostate for 3 years. She also seemed certain I had pc since most men my age have it and since a urine test for an infection was negative. (I would add I had been seeing a uro for prostatitis in my younger years and had had green light surgery that eventually resolved all my urinary problems. That urologist has since retired.) I went for a second opinion with a uro in nearby Scranton, PA who had been recommended by a friend. He concurred that my real psa score might be somewhere between 10 and 15, due to the finesteride intake. Given the high score, he scheduled a biopsy for this Friday. Both urologists did digital rectal exams and felt some hardness in left lobe. The Scranton uro also stated he thought the cancer was contained. Both recommended radiation plus hormone treatments, depending on the Gleason score. Both also noted I seemed fit for my age and I believe my overall health is fine. Any thoughts about this? Needless to say I'm a little anxious. Not looking forward to what's ahead, but both urologists seemed to believe I'd benefit from treatment.
Posted 6/6/2018 3:09 PM (GMT -5)
Well, they'd certainly benefit from pushing you through a biopsy then possible treatment...I'm not so sure you would. In fact, pretty sure you wouldn't.

Why the heck did you even have a PSA test? Your doctors are not following their own professional association's guidelines to not administer the PSA test to anyone with less than 10-15 years life expectancy. The plain and simple reason for this: if the patient hasn't had issues up to that age, then any PC they have (and they DO probably have PC) is already moving so slowly that it will not bother them if left alone in their lifetime. You are age 85. You said you are in "relatively good shape," but you would have to be in "extra-ordinarily good shape" to have life expectancy of 10-15 years (overall average LE for your age is less than 6 years).

If you have a biopsy, they WILL find PC (85% probability). Then what?

Consider walking away. Welcome to this site, but consider walking away from these docs.

Post Edited (NKinney) : 6/6/2018 2:55:41 PM (GMT-6)

Posted 6/6/2018 3:09 PM (GMT -5)
I had a friend that was in that place when he was 87. He got brachytherapy, no Luprolides. He was bummed over the bleeding, but kept on putting along nicely to 94.

I think we here are all a little nervous, off and on, self included.
Posted 6/6/2018 3:17 PM (GMT -5)
This is a very, very, tough call....At 85, an invasive procedure like a biopsy can not be taken lightly..You want to preserve your quality of life as much as possible, not get involved in treatments that for sure will have a negative impact on your QOL...If you are in really good shape for an 85 year old, maybe you could endure a biopsy and at least find out whether you have cancer and if you do, just how aggressive that cancer is likely to be....From that point on, it's one can of worms after another..
Posted 6/6/2018 3:30 PM (GMT -5)
Welcome to HW.

It's a tough call. Yes, it's likely you have some PC, but you're more like to die with PC than from PC.

A biopsy isn't the most pleasant thing in the world, but it's doable. I don't worry about chronological age much. At 68 my father was elderly and frail. If you're fit and strong at 85, then you should be able to tolerate the procedure.

The question will be, if you test positive, what to do about it. I wouldn't speculate now since that's based on the result.

Learn all you can about that - that's the best way to beat the worry. Not matter what happens, PC is a very treatable cancer and every hope for this being no more than a bump in the road.

Andrew
Posted 6/6/2018 4:11 PM (GMT -5)
Please fill out the following nomogram. It asks about comorbidities and biopsy results. When you get to Section 5, enter your age, T stage =T2a, Grade=10, and PSA=15 (we're making it worst case). It will show you:
(1) the probability of dying of any cause in the next 10 and 15 years if you do nothing
(2) the probability of dying of prostate cancer in the next 10 and 15 years if you do nothing
(3) the probability of dying of any cause other than prostate cancer in the next 10 and 15 years if you do nothing

/webcore.mskcc.org/survey/surveyform.aspx?preview=true&excelsurveylistid=4

I think it will show you that the probability of your dying of prostate cancer is very small (about 7%) even if you have very virulent prostate cancer and you do not have a biopsy or any other treatment.

You can use this probability to help you decide if you want to have a biopsy and get treated. Of course, these are just population averages and your case may be different. There is no right and no wrong answer - it's up to you.
Posted 6/6/2018 6:56 PM (GMT -5)
Sounds a bit off to me. I mean why a PSA test at your age and EXTRA why a biopsy.

Actually I was just talking to a friend today he is 84. He knows I have been treated for PCa. He told me that 15 years ago his PSA was 55. He refused BX and any treatment. Just 3 days ago he was in the hospital for heart issues. They ran some blood tests to include PSA ( unknown to him ) and then next thing he knows here stands a Urologist telling him "Oh my God you have a PSA of 66" we have to do something about that. My friend said he gave the Dr. the finger and threw him out of his room. Knowing this guy I am sure that is exactly what he did.

Ultimately your choice of course but if you are doing well, feeling and enjoying life why screw with it?

I wish you the best as I do all beings.

Roger
Posted 6/6/2018 7:13 PM (GMT -5)
Im new here but I would have the biopsy done. It isnt all that horrible and would possibly allow you some peace of mind. Yea you probably do have PC but at 85 if its Gleason 7 or 8 etc it still from what Ive read isnt going to be the end of you. Something else will be.

I wish you the best of luck.
Posted 6/6/2018 7:50 PM (GMT -5)
Allan is absolutely correct. Your probability of dying from PC is very low even in the worst case scenario.

You will be making the biggest mistake as any treatment at your age will result in a quality of life you will regret.
Posted 6/6/2018 8:09 PM (GMT -5)
no biopsy no treatment...you da one who went to the urologists(2)...that breathes concern...medicos are extremely sensitive to concerns...no way they are going to say goodby...feggid about it...its called liability


Murph a biopsy for a 43 y/o is different for an 85 y/o man...then you gave all the right answers as to why a biopsy or treatment really is not required... confused
Posted 6/7/2018 12:14 PM (GMT -5)
Although I hope you don’t go through biopsy - but if you have made up your mind on finding out if/how much/ of Cancer you may have - I would go through an MRI instead of biopsy.
Posted 6/7/2018 12:31 PM (GMT -5)
you didn't need a psa in order to know you've probably got some prostate cancer. I hope things work out in your best interest.


take care

Post Edited (island time) : 6/7/2018 11:39:32 AM (GMT-6)

Posted 6/7/2018 2:58 PM (GMT -5)
One of the questions is life expectancy if you think 15 or so years is probably, get the biopsy and deal with it. If you are on the short side genetically and only expect 5 maybe reconsider.
Posted 6/7/2018 3:30 PM (GMT -5)
Thanks, all. Your input gave me real pause but I'm going ahead with the bx because of my high psa score. Hopefully, it'll be tolerable. Tall Allen, I did check out the nomogram--but it seems to raise more questions than it answers, given my age. Sure, I probably won't live another ten years--but there's a big difference between surviving for another 6 or 7 and dying in the much nearer future. It's also true that the more aggressive cancer hits older guys more frequently. I'd add that my mother died only 3 years ago at age 103. She was still driving at 96 and lived independently till the end.
Posted 6/7/2018 3:46 PM (GMT -5)
The biopsy is annoying, uncomfortable and undignified. Most men tolerate them well. Some get pain during the procedure, so you want to ask the URO about that.

Let us know what the results are,
Andrew
Posted 6/7/2018 3:48 PM (GMT -5)
Sorry, but I don't think that there is evidence for the statement that the more aggressive cancer hits older guys more frequently.
As others have said, you have had prostate cancer for a long time, but didn't know it.

As an aside, based on your mother's longevity, it looks to me that you may well live another ten years (or more).
Posted 6/7/2018 4:16 PM (GMT -5)
Sailor, I'm no expert but I've read several articles showing men over 70 are subject to more aggressive prostate cancer. Try searching this, I think you'll find that is the case.
Posted 6/7/2018 6:42 PM (GMT -5)
Let me clarify my last statement. I didn't mean to suggest that the pc that hits men over 70 is not in the main indolent. The vast majority of old men have a slow-growing condition. I only mean to suggest that it would stand to reason that since pc hits older men primarily, the sheer number of aggressive cases will outweigh anything found among younger patients.
Posted 6/7/2018 6:56 PM (GMT -5)
Writeblock - you're a rare case. We don't get many many men showing up here at your age.

some of us forget the concept of chronological age vs physiological age. Clearly your physiological age must be lower than your chronological. Assessing risk is a tricky game and how it plays out for each person varies wildly.

What you need now is more facts - the biopsy.

Andrew
Posted 6/7/2018 7:37 PM (GMT -5)
It bodes well for you that you have posed the questions, listened to the response and then made YOUR decision. I wish you the best.

Roger
Posted 6/7/2018 8:24 PM (GMT -5)
Writersblock you are so wrong on so many issues...but your mind is made up...that is fairly obvious...I do have a question tho...do you invest in the stock market and are you what is considered considered a contrarian investor...not to be a wise arse...you strike me as one who at 85 does what he wants...I admire that in a human being...tho it begs the question as to why you even asked the question of us...be honest...you knew all along what you were going to do...no shame...we support you...good luck...there are no meaningful side effects from a biopsy...the question then will be...what will the man with the writersblock do with the diagnosis...at its worse...you take care of yourself

a side note... 95 y/o man from my gym had a RRP a year ago and is happy as a clam that he can piss so well...he now uses a can that he didn/.t before and still drives his car out and about ...his name is Frank
Posted 6/7/2018 9:07 PM (GMT -5)
How is there right or wrong in whether or not to have the biopsy? Ultimately it's an individual choice, though I did for a while consider canceling everything. I feel it's better to know what I've got and maybe--if it's aggressive but still contained--aim for a cure. How does that make me wrong?
Posted 6/7/2018 9:13 PM (GMT -5)
I my book, you're doing the right thing by asking questions and deciding to do the biopsy.

Others will disagree, but in the end it's your body, your life, your decision.

Feel free to ignore or accept advice from this forum as you see fit.

Andrew
Posted 6/7/2018 9:58 PM (GMT -5)
There's certainly no objective right or wrong about doing a biopsy in your situation, though some people make decisions without all of the relevant facts and some others make irrational decisions even with the relevant facts in hand. If it were me in your situation I wouldn't have the biopsy, but, well, it isn't me so it isn't my decision, and I respect and admire the way you made yours.
Posted 6/8/2018 12:28 AM (GMT -5)
I never said you were right or wrong on your selection if you were referring to me or fo that matter...did anyone else...In said you where wrong on so many issues...that's my opinion...Im not going to item by item go into it...Im just a forum hack from Hackensack...there will be no hanging tonight...live well...laugh often...love much... chill...
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