Prostatectomy for an 80-something-year-old
Editor's Note: A new Mayo Clinic Cancer Center study indicates that prostatectomy does not need to be automatically excluded as an option for octogenarians.
The father of a friend of mine turned 88. Shortly afterwards, he had a massive heart attack, and went into the hospital for a bypass. During the tests that went along with that procedure, it was discovered that he had prostate cancer.
I don't know what the exact Gleason score was, but my friend said it wasn't particularly high. Nevertheless, her father decided to have a prostatectomy surgery to remove his entire prostate gland.
When I expressed surprise at her father's decision, my friend said, "You don't know him: he's extremely independent-minded"
I replied that I wasn't concerned about his independence of mind; I was concerned whether his oncologist or heart surgeon, or anyone else, had told him 1) since he was 88, and had severe health problems, the likelihood of dying of something other than prostate cancer was extremely high, and 2) the addition of another surgery on top of his bypass might be the straw that broke this very fragile camel's back.
The man went ahead and had his surgery. A month or so later, I went to a party given by my friend. Into the dining-room came a tall, grey-haired man, limping slightly, but otherwise apparently in good health. This was my friend's father, fully recovered from both heart and prostate surgery.
"Last week, he was in the hospital, in the ICU," my friend said. "Today, well you see"."
This story raises all sorts of questions in my mind. To begin with, who am I to tell anyone else not to get treatment for cancer? Next, what kind of advice did my friend's father get from his doctors? Third, what are the real odds that he might have died from prostate cancer, or even gotten seriously ill from it?
To answer the last one, I would have to know more about his Gleason score, but here are some statistics, gleaned from the National Cancer Institute website:
- Only 3% of men diagnosed with prostate cancer died from it.
- Of the 121,000 men who died from prostate cancer between 2000 and 2003, the NCI says that 42% were between 75 and 84 years of age. 30% were over 85 years of age.
The statistics don't differentiate who had what kind of a Gleason score, whether all the deaths were from metastasized cancer, etc. They also don't say what chance there is of dying from heart disease vs. prostate cancer. But those are the facts. You can parse them as you wish.
As to what kind of advice my friend's father got from his doctors, I don't know. But I do know that the message being given by responsible oncologists and urologists these days is this: "Tell your patient all that he needs to know about what we do and do not know about the course of this disease and treatment options." In other words, let patients in on the fact that we still don't have complete clinical data about survivability after treatment.
Finally, what business of mine is it if an 88 year-old man who is apparently in serious physical distress wants to get his prostate taken out? If he doesn't mind the possibility of incontinence, or has a surgeon who can work around the tiny nerves, if he thinks he may live to 100, if he doesn't want to have to worry about cancer leaving his prostate and migrating into his bones then why shouldn't he make up his own mind and do as he wishes?
Absolutely. He should.
But I'm not sure I would do the same.
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