What is the best treatment for prostate cancer in old age?

Question

Hello doctor,

My father, who is 72 years old, was recently diagnosed with localized prostate cancer (Gleason score 3+4, PSA 9.2 ng/mL). His physician discussed potential management options, including active surveillance and radiation therapy. He is particularly concerned about the risk of side effects such as urinary incontinence and erectile dysfunction.

We would appreciate your guidance on how to determine the most appropriate treatment approach given his age, cancer stage, and overall health.

Please help.

Thank you for your guidance.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

I hope all is well with you, and I wish your father great health and well-being.

First and foremost, I want to acknowledge and empathize with the normal fear and anxiety that comes with receiving a prostate cancer diagnosis. Please rest confident that treatment options for prostate cancer have evolved greatly, and in your father's instance, the disease was detected at an early and favorable stage.

Given his current clinical findings (attachment removed to protect patient’s identity), active surveillance is an ideal and effective management strategy. This strategy entails close monitoring, with PSA testing every three months, a digital rectal examination every year, and a prostate biopsy once a year. If there is any sign of disease development, we would proceed with definitive treatment, most typically radiation therapy.

Active surveillance is preferred at this stage because the tumor is confined and does not appear to be aggressive. This allows us to avoid unneeded treatments while closely monitoring the condition. If your father's PSA levels rise or there are other symptoms of progression, we recommend starting treatment tailored to his specific condition.

If treatment is required, radiation therapy would be our preferred option. Radiation therapy is more precise and targeted than surgery, which has a higher risk of long-term adverse effects, including erectile dysfunction and urine incontinence. Its adverse effects are normally modest and transient, with the most prevalent being short-term bladder irritation or stomach discomfort that fades within one to two weeks of treatment.

Radiation therapy is generally safe and effective, with few long-term negative effects. However, as long as the PSA level remains below 10 and the Gleason score remains at 7, continuing with active surveillance is a very reasonable and safe strategy.

Treatment options include active surveillance or radiotherapy (if progression occurs).

Follow-up duration: 7 days.

I hope the information helps.

Kindly revert so I can assist you further.

Thank you.