Managing Prostate Cancer in Elderly Patients: A Guide for Families - Urology

Dr. Xu Weikai reply Urology

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Mr.
Gao: Hello, actually, whether to perform a biopsy or even whether to proceed with treatment should depend on the opinions of the patient and their family.
Age is a consideration, but it is not the only factor.
Let me first outline my general principles: 1.
For patients under 65 years old, I strongly recommend a biopsy; for those over 75, it is usually not performed unless the patient is in good health and has a high willingness to proceed.
For those between 65 and 75, it depends on the patient's condition and the physician's assessment.
2.
In elderly patients without symptoms or those whose urinary issues can be managed with general (non-cancer) medications, surgery is generally not recommended.
3.
If there are symptoms such as difficulty urinating or urinary retention, or if the response to medication is poor, further evaluation is recommended, including a biopsy or even a transurethral resection of the prostate (TURP).
4.
I will first discuss with the patient and their family whether, if the results are malignant, they would consider further surgery, such as radical tumor resection (which takes about 4-8 hours and requires a specialized hospital and experienced medical team), TURP (which usually takes less than 60 minutes but does not completely remove the tissue, only alleviates urinary symptoms), or a combined orchiectomy (which can reduce male hormones to control the spread of the tumor), or whether they prefer to manage it with medication regardless of whether it is benign or malignant.
Using general medications for benign prostatic hyperplasia can also be combined with cancer treatments (including hormone therapy), or they may choose to disregard it and treat it as benign.
I believe that a standard prostate biopsy is relatively simple and carries low risk; if the patient's health permits, I would recommend undergoing the biopsy.
After all, cancer treatment is quite specific, and a pathology report is necessary for subsequent treatments and evaluations.
Of course, there are cases where patients do not wish to take any risks associated with a biopsy and do not want any aggressive cancer treatment, opting instead for benign management; conversely, some individuals, even at an advanced age, still pursue aggressive treatment.
It depends on the attitude of the family and the patient towards the disease.
My suggestion is that you and your family can discuss my fourth point carefully: if the biopsy results are malignant, what will your attitude be? If you decide to do nothing and just want to know the condition, then I believe a biopsy is unnecessary, as it would serve no purpose.
If you have even a slight willingness to consider further treatment, then you may contemplate whether to proceed with a biopsy (depending on the patient's health status and willingness).
Additionally, you can look into the risks associated with prostate biopsies and related surgeries: I recommend checking our hospital's website: Taitung Hospital, Department of Health, Executive Yuan www.tait.doh.gov.tw, select Taitung branch, then navigate to the left column / Department Introductions / (Medical Department) Urology / left column select Data Download / Surgical Instructions for Transrectal Ultrasound-Guided Prostate Biopsy / Transrectal Prostate Biopsy / Transurethral Resection of the Prostate, or directly connect to the following URL: (I am not sure if this website provided by the Department of Health can be accessed this way) http://www.tait.doh.gov.tw/main_sec.php?index=ufile_sub&bsid=&no=09&sid=09&pid=51.
Note: Some clarifications: 1.
If the biopsy result is malignant, it is definitely malignant; however, if it is benign, it only indicates that the sampled tissue is benign, and it cannot completely rule out the possibility of malignancy.
In fact, some physicians may arrange for a second biopsy (I have a patient who underwent six biopsies across three hospitals before finally being diagnosed with malignant prostate cancer).
2.
The subsequent surgeries and treatments for prostate cancer vary significantly and depend on the patient's health and the attitudes of the family and patient regarding treatment options.
Therefore, I suggest that you gather sufficient information and discuss it with the attending physician before deciding on a treatment plan.
3.
Prostate cancer generally does not progress rapidly, with metastasis primarily to bones and internal organs; patients rarely die from the cancer itself.
They usually die from complications or other diseases (such as cerebrovascular disease, aging, etc.).
This is why factors such as age and health status are often considered, as the decision to treat prostate cancer may not significantly impact life expectancy compared to other diseases (hypertension, stroke, diabetes, etc.).
4.
If there are already symptoms and the patient's health is relatively good, sometimes I recommend a biopsy combined with TURP.
This way, there is only one anesthesia risk, and regardless of whether the result is malignant, it can at least resolve urinary issues.
(If your father is not in good health but your financial situation is decent, I would suggest considering laser prostate vaporization, which has significantly lower risks and almost no bleeding; whether to proceed with a biopsy at the same time would depend on your opinions.
Of course, this may be slightly off-topic.)

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Reply Date: 2010/11/11