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85 years old with fluctuating PSA. Cancer found in biopsy. Need of testicle removal?

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Dr. G.Srinivasan

Urologist

Practicing since :1991

Answered : 1414 Questions

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Posted on Mon, 24 Dec 2012 in Sexual Problems
Question: Hello , I will have my 85-th birthday next March , and am feeling relatively well ! About 2 -1/2 years ago my PSA increased to around 12, and the following biopsy indicated that ONE sample out of 12 had a XXXXXXX 8 type of cancer cells. The bone and cat scans indicated that this cancer is localized only to that one sample - so far ! I was on "waiting to see" schedule , taking only a couple of homeopathic pills ( Can Arrest , and Prostate-Pro ), and for almost two years my PSA fluctuated a couple of points - around 12 to 15. Then , a couple of months ago , it went up to 25, and again in a couple of months to 35.
My urologist doctor suggestged that the best alternative would be removal of testicles with some additional medications. Considering that my "sex life" has anyway come to close to zero, that does not bother me too much. What are the chances that this procedure will result in arresting progression of cancer, and what can I expect in the following few years of my life .

XXXXXXX
doctor
Answered by Dr. G.Srinivasan 1 hour later
Hi,
Welcome to XXXXXXX and thanks for your query.
It is high time an option of selection for prostate cancer is started.
The life expectancy in USA is 78 years.
This is used to decide the line of treatment at the time of diagnosis.
Generally the younger the age, treatment is undertaken with curative intent (removal of the prostate gland or radiotherapy).
At your age, hormonal treatment (removal of testicles) is the best option.
With a PSA of 35, the stage of the cancer is likely to be STAGE 3 (LOCAL SPREAD) or STAGE 4 (SPREAD TO BONES). XXXXXXX 8 is considered high grade cancer.
The next step would be to repeat the bone scan.
If testicles are removed, the following can be anticipated. PSA will drop to less than 5 in 1 month.
In stage 3 disease (local spread), 70 to 80% of people are expected to live 5 years.
In stage 4 disease, five year survival is 30%
This is a general guidance for the population.
Cancer behavior varies in individual patients and in reality, survival may even be better. I will quote two examples to make you comfortable.
One of my patients with a PSA of 27 at diagnosis is healthy after 3 years of surgery. Now he is 70 years of age. Another one is no more, but lived for 18 months, but his PSA at diagnosis was 862. He was 65 at diagnosis.
Hope this helps, kindly do not hesitate to revert back for doubts if any.

Regards
DR GS

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. G.Srinivasan 27 hours later
Obviously, according to your answer, I should be glad that I might end my LONG life journey by enjoying at least another FIVE years of it ! OK, I have informed my doctor that I have opted out for sergical removal of my "equipment", ( only a part of it , ha, ha, ha ), but here is my following question. As you say, that my PSA would drop to 5 or so in about one month after the sergery, does that mean that the spread of cancer has been arrested ? And, if I have a good diet and mild exercise, do I have a chance of continuing to be active, mentally and physically ?
Thank you in advance, Dan Kustudich, YYYY@YYYY
doctor
Answered by Dr. G.Srinivasan 28 minutes later
Hi
Welcome back.
To estimate approximately the aggressiveness of any cancer, five year survival is used as a research tool. It is something similar to life expectancy of a particular group of population and that's all it means.
Prostate cancer is a hormone dependent cancer and hence getting rid of the testosterone should control the growth of the cancer significantly and that's how PSA drops after removal of the testicles. ANDROGEN INDEPENDENCE happens over years and the tumour starts to regrow.
Mr Huggins was awarded Nobel prize for benefit of androgen ablation in prostate cancer in 1945 and it is still one of the best methods practiced.

You can live a healthy normal lifestyle and it is one of the good cancers to have, if one is sentenced.
Hope i have reassured you.
Regards
DR GS



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. G.Srinivasan 2 days later
Hello Dr. GS , I would be very thankful if you explained in "plain language" the meaning of your sentence : XXXXXXX . ANDROGEN INDEPENDENCE happens over years and the tumour starts to regrow XXXXXXX What you mean by XXXXXXX ..over years. XXXXXXX and what could be done when XXXXXXX ....tumour starts to regrow ?
Than you in advance,XXXXXXX
doctor
Answered by Dr. G.Srinivasan 2 hours later
Hi
Welcome back.
The tumor cells which initially regress to the androgen withdrawal in the form of orchiectomy (removal of testicles) learn to regrow even without androgen. Lots of research is going on in this.
This is called androgen independence. It takes a few years to happen even though it is not possible to predict the exact time. This is identified by rising PSA.
Beyond this limit, usually only palliative care will be offered.
Treatment for Pain, urinary difficulty and other problems that can arise will be treated appropriately.
Hope this helps.
Regards
DR GS


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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