At 68, should my dad continue prostate cancer treatment?

Question

Hello, Doctor,

My father is 68 years old and was diagnosed with localised prostate cancer two years ago and has been on active surveillance since then, as his Gleason score was relatively low at the time. His most recent PSA reading has risen noticeably from his previous test, and his urologist is now recommending either radiation or surgery.

My father is feeling extremely fatigued from years of anxiety and monitoring and is openly questioning whether continued aggressive treatment is the right path at his age. Please tell me,

Should I keep treating prostate cancer at my age, at 68, when the physical and emotional toll of treatment is this significant?
At what point does active surveillance become inadequate, and immediate intervention become unavoidable?
Are there quality-of-life-focused treatment options that balance cancer control with preserving his daily functioning and wellbeing at this stage?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I understand how much fear and concern you have regarding your father’s condition. This situation can feel overwhelming, especially when an important treatment decision is needed.

Active surveillance can be appropriate for your father in earlier stages, but this phase may no longer be suitable once PSA (Prostate-Specific Antigen) levels begin to rise or the Gleason score starts to change. At that point, it is generally advisable to consider active intervention.

The choice of treatment depends on the patient’s overall health and fitness. If he is in good general condition, surgery may be considered as an initial option. However, in recent years, there has been a shift away from surgery in some cases due to the possibility of long-term side effects such as

Urinary incontinence,
Loss of libido.
Erectile dysfunction.

These factors can significantly affect quality of life.

Because of this, radiation therapy is often considered. Modern radiation techniques, such as Intensity-Modulated Radiation Therapy (IMRT) and CyberKnife, are designed to be highly precise and targeted, focusing on the tumor while minimizing impact on surrounding tissues. Side effects may include mild urinary or bowel symptoms, which often improve after the completion of treatment.

In certain situations, when surgery or radiation is not suitable. Hormonal therapy may be considered for your father in such cases. This approach may lead to side effects such as reduced libido and changes in body composition due to lower androgen levels, and it typically requires close monitoring and follow-up.

Overall, there are multiple treatment options available. The most appropriate choice depends on individual factors, and a detailed discussion with a specialist can help guide the decision.

I hope this information helps you.

Feel free to ask further queries.

Thank you.