Senior Living: This is who prostate cancer affects and how it should be treated
By Dr. Thomas LaGrelius
I just discovered a much-loved relative in his 70s has prostate cancer. He and his wife are investigating their many options. Deciding what to do about it is tricky.
Pearls to keep in mind:
- We identify 165,000 new cases annually, but only 30,000 men die of it each year. Thus, the death rate is less than one-fifth of the diagnosis rate. Furthermore, more than 3 million men, or one in 50, are living today with prostate cancer. Only 1% of these men die of it each year while 99% of them do not. That’s the first piece of good news! It’s a common disease but the death rate is low. Twice as many people die of the flu.
- The average age of discovery has dropped to 66 because of widespread use of Prostate Specific Antigen, screening blood tests. Prior to the use of PSA, the average diagnosis age was 71, when the disease was more advanced. Now, more than 90 percent of diagnoses happen in the early stages.
- Prostate cancer grows very slowly in older men. The older you are when the disease begins, the less likely it will ever hurt you. More good news, at least if you are older.
- Men diagnosed with prostate cancer under age 60 are uncommon, but often have an aggressive disease. I’ve never personally seen a case under age 45. These young cases are usually fast, nasty and hard to treat. The tumors are so bizarre some of them don’t even make PSA. My 45-year-old patient had a large, hard prostate mass, but his PSA was normal. He died within a year, leaving a young family, despite monumental efforts to save him.
- In contrast, almost 100 percent of older men with local or regional prostate cancer survive five years; 98% are alive 10 years later (if they have not died of something else first, that is).
- Here’s a shocker. Literally 100% of men age 100 and above already have prostate cancer. Autopsy studies on centenarian men who died of other diseases prove this, but most were unaware. The closer you get to 100 the more likely you are to harbor prostate cancer and not know it.
- Also, 80% of men have cancer cells in their prostates by age 80 and almost all of them will die of something else before it ever becomes a problem. Many will live out their lives unaware. That is a great case for NOT screening older men, especially those with short life expectancies. The anxiety and life disruption caused by receiving this diagnosis may be worse for the patient than the disease itself. To calculate your own life expectancy go here: media.nmfn.com.
- Men discovered to have localized prostate cancer after age 75 rarely die of it. They die “with it” but of something else. If they do die of it, they do so as very old men. Because of this, the US Preventive Services Taskforce no longer recommends that men 70 years of age or older be screened for prostate cancer at all. See: uspreventiveservicestaskforce.org.
- Prostate cancer treatment can do much harm! At least 4% of treated patients end up with incontinence and/or impotence. Treatment disasters are rare, but do occur. Three years ago, I diagnosed a 68 year old with a new, large prostate nodule. It was biopsied, a Gleason 8 (severity scale, worse than average) tumor. He chose to have a radical prostatectomy at an excellent, famous university center. He died after surgery from medical complications. I greatly miss him, as does his wife, also my patient. At times, I wish I had never done a rectal exam on him. Had I not done so, he would be alive today and unaware of his problem.
Recently, my wife and I attended a birthday party for a friend and patient turning 99. He still runs his business. Years ago, I found his prostate nodule. He has never been biopsied or treated. He is asymptomatic but does have an elevated PSA. He will not die of prostate cancer or its treatment.
The decision to screen, biopsy, treat with radiation or surgery, or observe is a complex individual thought process, but here is my personal view: I will be 76 in two weeks. By the calculator above, my life expectancy is 95, though I hope to do better. If I had prostate cancer today, I would refuse biopsy or treatment.
Live long, be well.
Dr. Thomas W. LaGrelius, M.D., F.A.A.F.P., is a certified specialist in family medicine and geriatric medicine. He is the founder and president of Skypark Preferred Family Care, a concierge primary care/geriatrics practice based in Torrance www.skyparkpfc.com. He is a staff member at Torrance Memorial Medical Center and Providence Little Company of Mary Torrance Hospital. Email questions and topic suggestions to firstname.lastname@example.org or call 310-378-6208.