Prostate Cancer Treatment Options for Elderly Patients

Prostate cancer

Hello Dr.
Chen, my father is 81 years old and had a PSA level of 14.9, which led to a prostate biopsy that confirmed the presence of cancer cells.
The doctor then arranged for a CT scan of the pelvic area, a chest X-ray, and a nuclear medicine scan of the entire skeleton, fortunately confirming that there was no metastasis.
The doctor recommended laser surgery to remove the prostate, followed by monthly hormone injections for at least two years, and suggested that other specialists evaluate the need for radiation therapy.
My father does not have high blood pressure but has a history of diabetes.
Eight years ago, he underwent surgery and chemotherapy for early-stage bladder cancer, and the day after the prostate biopsy, he had a cystoscopy that confirmed no recurrence.
My father is mobile, does not have dementia, and is still able to ride a motorcycle; overall, he is in relatively good health.

I would like to ask, based on my father's condition, what effects can be expected on his body after prostate removal surgery? Will he experience frequent urination, incontinence, or even urinary incontinence? What are the positive and negative effects of hormone injections on his body? Is it mandatory to receive hormone injections? What would happen if he does not receive them? Additionally, I am concerned about the potential harm of surgery given his age.
Are there alternative methods to prostate removal? Can radiation therapy or other non-surgical treatments be used instead? I apologize for the lengthy message and appreciate your guidance.
Thank you.

J, 50~59 year old female. Ask Date: 2020/04/14

Dr. Chen Sirong reply Oncology

J / 52 years old / Male
Hello!
1.
The doctor recommended laser treatment to remove the prostate.
A: This procedure is likely not aimed at prostate cancer but rather at benign prostatic hyperplasia (BPH).
What I mean is: for BPH, laser treatment is applicable; for prostate cancer in an 81-year-old, hormone therapy plus radiation therapy is recommended; for prostate cancer in patients under 75 years old, options include self-funded Da Vinci surgery or standard prostatectomy covered by insurance.
2.
After the prostate removal surgery, what effects will it have on the body? Will there be frequent urination, leakage, or even urinary incontinence? A: Laser treatment is not my specialty; you can refer to https://www.google.com/search?q=%E9%8A%A9%E9%9B%B7%E5%B0%84%E6%B8%85%E9%99%A4%E6%94%9D%E8%AD%B7%E8%85%BA&rlz=1C1SQJL_zh-TWTW886TW886&oq=%E9%8A%A9%E9%9B%B7%E5%B0%84%E6%B8%85%E9%99%A4%E6%94%9D%E8%AD%B7%E8%85%BA&aqs=chrome..69i57.3095j0j8&sourceid=chrome&ie=UTF-83.
3.
What are the positive or negative effects of hormone injections on the body? Is it necessary to have hormone injections? What happens if I don't get the injections? A: Hormone therapy has negative effects on the body but positive effects on the disease.
It is necessary to administer injections based on the condition, which may last for six months, one and a half years, three years, or a lifetime.
Please consult your father's doctor; not receiving injections can lead to recurrence, as injections compensate for the lack of hormones.
It may accelerate aging, but patients may not necessarily feel the side effects.
4.
I would like to ask the doctor, if I do not want to undergo prostate removal surgery, what alternative options are available? Can I only use electrotherapy or radiation therapy? A: Yes, you can use electrotherapy or radiation therapy alone! For BPH, laser treatment is applicable; for prostate cancer in an 81-year-old, hormone therapy plus radiation therapy is recommended; for prostate cancer in patients under 75 years old, options include self-funded Da Vinci surgery or standard prostatectomy covered by insurance.
Wishing you peace and joy,
Taoyuan Hospital, Chen Si-Rong

Reply Date: 2020/04/14

More Info

Understanding prostate cancer treatment options for elderly patients, especially those with additional health concerns, is crucial for making informed decisions. Your father's situation, given his age and medical history, requires careful consideration of the benefits and risks associated with various treatment modalities.

Surgical Options and Their Implications
1. Surgical Removal of the Prostate (Prostatectomy):
- Impact on Urinary Function: One of the most significant concerns following prostate surgery is the potential for urinary incontinence. While many patients experience some degree of incontinence post-surgery, most see improvement over time. However, some may experience persistent issues, including frequent urination or urgency. The risk of these complications can depend on factors such as the surgical technique used (e.g., robotic-assisted surgery vs. traditional open surgery) and the surgeon's experience.

- Sexual Function: Surgery can also affect erectile function. Nerve-sparing techniques may help preserve sexual function, but this is not guaranteed, especially in older patients or those with pre-existing conditions.

2. Hormone Therapy:
- Purpose: Hormone therapy, typically involving injections of medications that lower testosterone levels, is often used to slow the progression of prostate cancer. It can be effective in managing cancer that is confined to the prostate or has not spread significantly.

- Side Effects: Common side effects of hormone therapy include hot flashes, weight gain, fatigue, and potential impacts on mood and bone density. Long-term hormone therapy can also increase the risk of osteoporosis and fractures.

- Necessity: While hormone therapy is often recommended, it is essential to discuss with your father's oncologist whether it is absolutely necessary in his case. Some patients may opt for active surveillance or other treatments if the cancer is deemed low-risk.

Alternative Treatment Options
1. Radiation Therapy:
- External Beam Radiation Therapy (EBRT): This non-invasive option can be effective for localized prostate cancer. It typically involves several sessions over a few weeks and can be a suitable alternative for patients who may not tolerate surgery well.

- Brachytherapy: This involves implanting radioactive seeds directly into the prostate. It can be a good option for localized cancer and may have fewer side effects than surgery.

2. Active Surveillance:
- Given your father's age and overall health, active surveillance may be a viable option. This approach involves closely monitoring the cancer without immediate treatment, reserving intervention for if and when the cancer shows signs of progression. This can help avoid unnecessary side effects from treatment.

3. Combination Approaches:
- In some cases, a combination of treatments may be recommended. For example, radiation therapy may be combined with hormone therapy to enhance effectiveness, especially if there are concerns about the aggressiveness of the cancer.

Considerations for Elderly Patients
- Overall Health: Given your father's history of bladder cancer and diabetes, it is crucial to assess his overall health and ability to tolerate surgery or other treatments. Consulting with a geriatrician or a multidisciplinary team can provide insights into the best approach considering his age and comorbidities.

- Quality of Life: Ultimately, the decision should consider your father's quality of life. Discussing the potential impacts of each treatment option on his daily activities, mobility, and overall well-being is essential.

Conclusion
In summary, your father's treatment options for prostate cancer should be tailored to his specific health status, cancer characteristics, and personal preferences. Engaging in a thorough discussion with his healthcare team, including oncologists and urologists, will help clarify the best course of action. Whether through surgery, hormone therapy, radiation, or active surveillance, the goal should be to manage the cancer effectively while maintaining a good quality of life.

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