Prostate cancer--one for the medical journals

[SCadaddle]

I had posted about this last year in the "prostate cancer, it's my turn" thread that is several pages long. A catch up and update:

My Dad who is near blind and hears only what he wants to now that is still pretty active for recently turning age 96 (ninety-six) had his yearly physical last fall. The family is still puzzled why his GP gave him a PSA test at age 95. But he did and he scored a 24. Alarmed, the GP set him up with an Oncologist for more testing/diagnosis. Thought maybe an infection of the prostate. Gave him a two week round of antibiotics, come back and see me in 3 weeks. PSA tested again and he scores a 48. I thought we were done. Nope, 6 weeks later he tests again and scores a 124.
So in late December the Oncologist gives him a hormone therapy shot and prescribes a pill. Come back and see me in March. The March appointment was this past Tuesday. Come to find out somehow the order to take the pill wasn't understood by him or the family. Another hormone therapy shot and PSA test performed Tuesday. Results today. He scored a 12. TWELVE! Oncologist says forget the pills, come see me in 3 months.

However, not to be outdone by his little brother, his older brother at age 98 (ninety-eight) had a valve replaced in his heart about a month ago. Went in through his groin for the procedure. They did it on a Thursday, let him out of the hospital the following Tuesday and he attended a party at the hospital the following Friday celebrating the "First 50" to receive the procedure.

Mississippi may be last at a lot of things, but the medical profession isn't one of them.

[SCadaddle]

January 2015. Little brother on the right.

[Chocaholic]

Congrats on your great genes! Glad to hear both are doing well.

Regarding the valve replacement, TAVR (trans-aortic valve replacement) has been pretty common for 5-10 years. If the first 50 were completed a few weeks ago, they're about 5-10 years behind the average. Lots of formerly invasive procedures are now commonly done in the Cath Lab. Emory has done many thousands.

[aigel]

Awesome dudes. Love the old guy pants! I am glad they are still kicking.

G

[Nathans_Dad]

Who the heck is even looking for prostate cancer in a 96 year old? That's ridiculous. As a physician, there is no reason at all to even look for any cancer in a 96 year old, much less through a very questionable test like a PSA.

[recycled sixtie]

Those brothers are amazing. Yes I would question the need for major testing at that age. My fil used to have a colonoscopy in his 90's. He passed away at 98. For myself being 70 this year I will have one more in my 70's and I will call it quits after that.

My psa came down to 2.9 from 4.6 (likely coz I had a turp procedure - unable to pee). I will have blood work done regularly due high blood pressure and high cholesterol though....

Over testing is a pita and expensive for the system.

[creaturecat]

awesome looking old guys. those two.

[SCadaddle]

Originally Posted by Nathans_Dad

Who the heck is even looking for prostate cancer in a 96 year old? That's ridiculous. As a physician, there is no reason at all to even look for any cancer in a 96 year old, much less through a very questionable test like a PSA.

The family agreed with you on this. However, it was part of a diagnosis as to why he couldn't urinate very well due to an enlarged prostate. So at that point it became a "quality of life" issue vs. a "whats going to kill you first" issue. Hindsight is 20-20 and I'm glad they investigated things like they did.

These are a couple tough old birds. They grew up in the Great Depression in hard times of rural Mississippi. My Dad was a Lt. Commander in the Navy aboard a floating dry dock in Saipan/Tinian in charge of lifting and repairing destroyers and submarines in 1944 at the age of 24. Nowadays you can't find a 24 year old that can get your order right at a McDonalds. He served in the Naval Reserve well into the 1960's.
My Uncle was a Marine Corp Pilot during WWII and flew military "brass" well into the 1960's before he retired. I asked him recently "who was the most famous person you ever had aboard one of your flights?" He thought for a minute and then told me:

"It was in Guadalcanal. I was informed that we were going to fly a secret mission. Didn't know who or where. I was with the crew at the plane when this fellow arrives and I looked over and noticed his rank. I ordered the crew to salute. It was Fleet Admiral "Bull" Halsey. I asked him where we were flying. He said he'd tell me once we got in the air. So we get in the air and he says to steer to New Georgia Island---just formerly known as the Japanese base called Munda---so we get there and the field is still under reconstruction. We land and Halsey meets with a bunch of scrappy looking fellows and their leader, Greg "Pappy" Boyington."

I almost did a back flip. My Uncle met Bull Halsey and Pappy Boyington in the same day and I'd never known it had I not asked!

[Nathans_Dad]

If his issue was difficulty urinating the correct test would have been a digital rectal exam followed by a medication if enlarged prostate was confirmed. Simple.

I'm glad he's doing well, when I have patients over the age of 90 my main goal is to stay out of their way medically and minimize medications and testing as much as possible.

I had a attending physician in residency who used to tell us that our main goal in a 90 year old patient is to not be the reason they don't see 91...

[wdfifteen]

What is the medication for BPH?

[Nathans_Dad]

There are several, Flomax, Proscar, Hytrin, Avodart, etc.