How can a 62-year-old effectively manage prostate cancer?

Question

Hi doctor,

I am a 62-year-old man whose recent PSA test came back elevated at 8.2, and my urologist found a suspicious area during my digital rectal exam that led to a biopsy confirming prostate cancer.

I am having trouble urinating, getting up multiple times at night, and feeling like I cannot empty my bladder. I am scared about what this diagnosis means for my life expectancy and whether treatments will affect my ability to have a normal relationship with my wife.

My father died of prostate cancer 10 years ago, and I am worried mine might be aggressive too. What are my treatment options, and how do I decide between surgery, radiation, or active surveillance?

Please guide.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concerns.

Getting diagnosed with cancer is always overwhelming, particularly with a family history, and also losing your father to it. However, not all prostate cancers behave the same way. Some are aggressive, and some are slow-growing. The fact that you have picked up the disease so early is good. So do not worry about the life expectancy. With proper treatment, there are very good chances of long-term survival.

Your current symptoms of weak urinary stream, frequent urge to urinate, and the feeling of incomplete bladder evacuation are all due to an enlarged prostate. Medications like Tamsulosin (an alpha-blocker that relaxes the muscles in the prostate and bladder neck) will provide relief until definitive treatment is planned.

Since a biopsy confirms cancer, the Gleason score is particularly important for planning further treatment modalities. Low Gleason scores just require active surveillance (regular monitoring with tests like PSA and imaging).

Usually, moderate to high Gleason scores require surgical resection (removal) of the prostate gland. Before that, you will also need a bone scan or whole-body PET-CT scan (positron emission tomography - computed tomography scan) to assess the spread of the disease to distant organs.

Radiotherapy, along with hormonal therapy (treatment to lower testosterone levels, which fuel prostate cancer growth), is an alternative to surgery.

With surgery or radiation, side effects like erectile dysfunction (difficulty achieving or maintaining an erection) can happen, and they can be managed medically.

It is important to discuss this with your spouse and also the doctor before deciding on the treatment.

So, in short, discuss the biopsy Gleason score and imaging findings with your urologist. Based on this information, you can decide on the treatment that best suits you.

I hope this answers your query. Feel free to reach out anytime.

Thank you.