What is the best treatment option for an elderly patient with prostate adenocarcinoma?

Question

Hello doctor,

My father-in-law (79 years old) has been recently diagnosed with prostate adenocarcinoma - acinar type with a Gleason score of seven, grade group two. He is quite active physically and does his regular walks meticulously. He has no specific symptoms related to his prostate other than frequent urination that is controlled with tablet Dutasteride. He is medically fit for surgery. We are unsure if we should go for a radical prostatectomy or wait and watch. Are there any other treatment options for his condition?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for your query. I understand your concern. Considering his age, both surgery and the wait-and-watch approach are valid options. The decision to do a radical prostatectomy generally depends on the expected life expectancy of the patient. Generally speaking, if a person is expected to live for another ten years, he is a good candidate for surgery. So advanced age is not an outright contradiction for surgery. The wait-and-watch approach is also feasible and involves the patient taking hormones for medical castration. This is especially helpful if someone is currently not fit to undergo major surgery or if they have other illnesses which may cause morbidity or mortality before the prostate cancer does. The third option is to undergo radiotherapy to the prostate. Each approach has its own advantages and disadvantages, and the decision to choose one of the three options will be down to you. Was an MRI (magnetic resonance imaging) or PET CT (positron emission tomography-computed tomography) done for your father before or after the biopsy?

I hope this has helped you. Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

Your father will need a complete workup before you choose between prostatectomy, radiotherapy, and hormones. The treatment depends on whether the disease is localized to the prostate or has spread elsewhere. When was the biopsy done? I suggest you undergo serum PSA (prostate-specific antigen), and prostate-specific membrane antigen positron emission tomography (PSMA PET) with MRI (magnetic resonance imaging) screening.

I hope this has helped you. Thank you.

Answer 3

Right, I understand. However with the current biopsy report of cancer prostate, we need to find out whether the disease is limited to the prostate or has spread elsewhere. For this your father needs a PSMA PET WITH MRI SCREENING which needs to be done 4 weeks after the biopsy to reduce chances of artifacts. Once we establish the stage of the disease, we can discuss his treatment options. I hope this makes sense.