Elderly brother, PSA level concern.

Good morning Osca2023 .

Well done to your brother for getting tested but it has raised the recurrent question of to treat or not to treat. Your brother's age and life expectancy are being taken into account along with maintaining a good quality of life. As men age there is an increased likelihood of being diagnosed with prostate cancer but it is usually slow growing so what the doctors are trying to find out is the rate of that growth so that they have a base line. You don't say whether the DRE indicated anything but the fact that HT/RT has been mooted suggests that it has? 

I have attached an article which is a little old but might give you a bit of background information.

https://www.renalandurologynews.com/news/urology/prostate-cancer/prostate-biopsy-avoidable-in-some-elderly-men-with-high-psa/

Prostatescotland states the following -

For older men, routine or no referral may be appropriate (subject to clinical consideration) for PSA levels of:

• Age 80-85 years ~ more than 10ng/ml
• Age 86 years and over ~ more than 20ng/ml

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Hormone therapy comes with side effects and additional risks which can exacerbate co morbidities so it is a balancing act. 

As you have asked what people think then my two pennorth is that AS is a valid option at this time and make sure that the PSA is checked regularly BUT if your brother starts to have any urinary issues he should go straight back and ask to be re evaluated. If he is uncomfortable with this then he could ask for a scan which would at least give a indication of whether he has a problem.

This has raised the issue that family members should be advised that they are at higher risk of developing prostate cancer and get tested regularly.

Hi Oscar

I must say waiting until PSA reaches 20 is questionable.

When/if it reached 10 you would think they could offer him a MRI otherwise you're very much in the dark.

This is especially because he appears to be in good health, why risk it spreading.

Just my thoughts 

Best wishes 

Steve 

Thank you Alwayshope , yes he is 86 so the figures quoted by the consultant were along the NHS guidelines. From knowledge of my experiences he is aware of both the HT and RT considerations.

The DRE only revealed the enlarged prostate but no other concerns.

I will do my best to ensure that he follows up with the six monthly tests and to be aware of any urinary changes.

Thank you again for your input.

Rod

Thanks Grundo (Steve), from Alwayshope's comments above it seems that 20 is within the current guidelines for a man of that age. As he has two steel hip replacements the MRI may not be as straight forward as normal so perhaps that is why it wasn't offered immediately but it was mentioned as a possible in the future in the consultants report.

Thanks again,

Rod

Ok Rod ,I understand ref the possible issues with MRI

Regards 

Steve 

Hello Rod (Osca2023) 

For what it's worth I am in full agreement with Alwayshope here. At 86 years of age think quality of life is far more important than treatment unless it's essential.

Best wishes - Brian.

Thanks Brian, your reply and that of others puts my mind at rest. It's now a case of keeping a careful eye on the PSA level.

Rod