Questions to ask urologist

Hello Pepe 

So, everyone is different and each hospital trust works to their own set of rules and timescales. I am aware dad's age and how frail he is will come into the treatment plan. Here's a link to our guide to questions to ask your healthcare team - it's a general guide-

https://www.macmillan.org.uk/cancer-information-and-support/treatment/your-treatment-options/questions-to-ask-your-healthcare-team

I am not medically trained but the normal PSA for an 83 year old is 4 - so a PSA of 24.8 would indicate a high chance of a formal cancer diagnosis.

The usual route to a prostate cancer diagnosis is a biopsy and details of this can be found here in this link-

https://www.macmillan.org.uk/cancer-information-and-support/prostate-cancer/early-prostate-cancer

At dad's age and with his other health conditions they may well assume cancer without going through the biopsy which in all honesty is the hardest part of the diagnostic period.

You said he has CKD and his problems were passing water - that's just how I arrived here (you can read my journey by clicking on my name or avatar). My personal view at dad's age would be to ask if they can sort out his problems with the "waterworks" as the first priority and deal with the CKD next - Prostate Cancer can be slow growing and the treatments brutal to say the least.

I hope this helps - please don't be afraid to come back to me with any questions, however trivial - we have all been where dad is now - and it's not the best place to be.

Best wishes - Brian.

Thank you so much 

Hello Pepe, I’m sorry to hear about your Dad’s health conditions and yet I praise your very obvious concern for him.

you don’t say how advanced your Dad’s dementia is but I think his ability to understand and cooperate with the necessary diagnostic procedures and potential treatment must be considered. Dementia is no reason to withhold treatment if the patient can understand and cope with it, though.

i would suggest that you all consider the quality of life for your Dad. So, to have treatment etc if he can understand, withstand and cooperate with a rather rigorous ‘journey’ but, if not, to ask how he can be kept as well and symptom managed for as long as possible. 

I think, too, that if hormone therapy is proposed, you should ask if this will exacerbate his dementia symptoms. Certainly my husband suffered a ‘slowing down’ when on the hormone therapy - both physically and cognitively. The brain fog was hard to deal with at times - as was the fatigue and the low moods.

i hope this helps and I hope the consultation has the best possible outcome for your Dad.

Hi Pepe

Sorry about your dad, looks like he's going through a lot anyway and now something new to contend with 

See what the urologist says , hopefully they don't suggest a biopsy, even a MRI may prove difficult for your dad as it involves lying flat in a claustrophobic tube for up to half an hour.

Perhaps they can offer an easier type of scan like a CT.

Do u only have the one PSA result , hopefully they will do another.

Good luck with next week's appointment, let us know

Best wishes

Steve 

Thank you all. Dad had his appointment this morning. Dr did flow test and examination and said likely cancer but also said still not emptying bladder properly (been on tamulosin for a few days) but this could be linked to his dementia. She doesn't want to do a biopsy because it's too invasive for him and they won't treat the cancer either. She's ordered a bone scan to see if it's spread. 

How are we meant to know the grading/staging and prognosis without a biopsy? 

I couldn't go to the appointment so my mum took him and that's why I didn't ask this question to the Dr. 

Hello Pepe 

Thank you for the update - I thought that a prostate biopsy would be too much for dad and I am pleased he has been spared that one.

Without a biopsy there won't be a Gleason Score and TNM staging and his condition will be checked by constant PSA testing. 

I think as Prostate Cancer is usually slow growing dad's team are best looking at keeping his other issues in check.

I do hope the above helps, if you have any questions regarding the above please don't hesitate to contact me.

Best wishes - Brian.

Thanks Brian. If he is on tamulosin, won't that affect his PSA levels? 

Thanks Steve. That's my Dad's name too! 

He's just had one PSA test yes. She didn't repeat it. 

Yes we feel like it's one thing after another and it's absolutely getting too much for my poor Mum to cope with. There are so many different appointments etc. 

I understand why they won't do a biopsy but for me it would help to know the specifics of what we are dealing with. 

Thank you for your advice worriedwife. I definitely don't think he would understand treatment at all. His dementia is relatively advance and his short-term memory is non-existent :(

Hello Pepe 

Yes you are correct Tamsulosin can affect PSA levels, it can increase them and reduce them depending upon circumstances.

I think your team are quite aware of all the facts and they are treating dad as best they can to give him "quality time at his age".  I am not medically trained nor allowed to offer an opinion.

Pepe said:

but for me it would help to know the specifics of what we are dealing with. 

Although a full diagnosis would be desirable - with dementia and other issues going on I think the bone scan is the best course of action. It's pain free and will give answers as to any spread.

Best wishes - Brian.