Possible cancer diagnosis

Jazzma

My DH has been in memory care for 6 months at stage 5. His recent blood test showed a PSA number high enough (20+) to indicate likely prostate cancer. He is scheduled for a CT scan on Monday and his PCP has recommended he see a urologist.

I'm jittery. I understand most prostate cancer, especially at his age (75) is not fatal. At the same time I do hope for a reprieve for both of us before he reaches stage 7. I'd like to have a diagnosis and prognosis but I don't want to put him through testing (like a biopsy) that would be frightening and stressful for him.

Do any of you have experience with this? Could the scan alone indicate the characteristics of the malignancy, and whether it's spread? Thanks for any wisdom and thoughts you can share.

Quilting brings calm

I think you need to have a serious discussion with your PCP ( and if you choose to schedule a visit, the urologist). Most prostrate cancers are slow growing. If not, are you thinking that you’d have your memory care living, stage 5 spouse go through surgery? My spouse had laser prostrate surgery several years ago and came home with a catheter bag for a week. Would your spouse leave that alone or try to pull it out? Would he be able to deal with possible other treatments(chemo or radiation / not sure if those even apply)?

housefinch

Different situation, but our PWD was recommended to get a permanent colostomy to address a medical condition. We got a 2nd opinion and that surgeon recommended hospice and no surgery because he wouldn’t understand or remember why he had a colostomy bag. He was discharged to a memory care facility on hospice and is slowly declining 2 months later. I’m a physician and strongly opposed a colostomy but was not medical POA.

harshedbuzz

@Jazzma

I am so sorry this testing has rocked your world.

Since you can't unknow the result of that PSA, you have some hard decisions to make. My dad had a recurrence of prostate cancer diagnosed months before he was diagnosed with mid-stage mixed dementia. He'd had a diagnosis and radiation 10 years before his new PCP noticed his numbers creeping up. His Gleason Score was in the middle originally and his CT scan was clear except for the prostate, so my parents once again elected treatment. This time he was offered Androgen Deprivation Therapy which was a twice yearly shot of Lupron. He seemed to tolerate that OK, but I always noticed a slip in cognition around the injections though I couldn't find anything in the literature about that.

Has he routinely had PSAs that were higher than normal or elevating over time? Or is this a situation where the number jumped abruptly since the last test 2-3 years ago? Is the CT scan to see if it has already metastasized to his bones or abdominal organs? If it has, you may want to consider hospice as an option instead of treatment depending on what they offer.

Unfortunately, I'm pretty sure you're not going to get a prognosis, assuming it hasn't metastasized to other organs, unless they do the biopsy and send tissue samples out. This is the testing that is interpreted into a Gleason Score which will give a sense of whether he'll potentially die from prostate cancer or with it.

https://www.pcf.org/about-prostate-cancer/diagnosis-staging-prostate-cancer/gleason-score-isup-grade/

Thinking of you as you deal with new issue.

HB

M1

Oh jazzma. Sorry they even did the test. Like all such screenings, you almost have to know what you'll do with the information before undertaking it. I'd go for a don't ask, don't tell scenario and forget about it. I wouldn't put him through a scan or biopsy or anything. What possible difference could it make?

Rick4407

i had prostate cancer 4 years ago. I elected for radiation. It was probably the worst decision of my entire life. My DW was advanced dementia, she died 3 years later. I would follow the advice of M1 above and cut any diagnostic tests that do not involve "quality of life" issues. I was 75 and the continuing treatment complications have been a significant negative impact on my current quality of life. Rick

tucson anne

About the time my DH was diagnosed with MCI, he also had an elevated PSA which was a pretty sudden jump. He had a biopsy (he wasn't in the stage of cognition where this was an issue) and he had a small amount of slow growing prostate cancer. We elected for watchful waiting and dutifully trundled to the urologist several times a year for a few years. At some point he had another elevated PSA (his had been testing around 10) and to be sure we had it retested, and it was back to the lower level. Now I have decided not to continue monitoring this because any treatment options if it were worse would be too difficult (he's about stage 5). And of course all treatment options have consequences. I will add that prostate cancer runs in his family, but whether cancer or Alzheimer's wins, I'm not sure it makes a lot of difference. It is like every other possible diagnosis at this point—do you treat? Are you prolonging a life that he hates? Is dying in pain from cancer worse than lying in a bed with no cognition? So my philosophy now is let nature take whatever course she will take.

fmb

Jazzma, I am so sorry that you and he are going through this. I certainly understand your ambivalence.

DH was diagnosed with prostate cancer in 2002 at age 71 with a PSA of 4.9, Gleason (old system) of 3.3 and a biopsy. Watchful waiting was recommended. His PSA gradually increased over the years with a reading of 14.25 in 2020. We saw the urologist who said that the only treatment option at his age (89) was chemical castration. DH rejected that upon learning about the side effects, especially thinning of the bones (he was already falling frequently). He has not been tested since.

At this point, I would suggest going ahead with the CT scan if your DH is capable of cooperating with the test. If it appears to be metastasizing, place him in hospice care. They are equipped to deal with pain issues so he does not suffer as the disease progresses. Further testing at this point in his dementia progression would serve no purpose.

JJ401

DH has high PSA. Opted for biopsy. Some scattered cancer found.
Numbers went up. Another biopsy. No cancer found.

The numbers stabilized and he’s still seeing the urologist. But, last time were there I spoke to the urologist privately and told him no more biopsy. He’s reached the stage where the reward risk factor is more toward risk. He’ll go back for a PSA. But, the reason is the urologist is much more responsive prescribing for an UTI than his primary.

Jazzma

Thank you all for your comments. I already know that we will not treat the condition, whatever it is. I just want to know if the cancer will take him before the Alzheimer's does, and if so, is there a timeline? If we're in hospice territory I will bring him home for the duration.

Pat6177

Jazzma, we’re in a similar situation. 5 yrs ago, DH had an abdominal MRI done and they happened to spot a lesion in the lower part of his lung. He then went to see a lung doc and had CAT scans for 3 yrs - no cancer, no change in lesion. Last Lung CAT scan was (I think) 2022. DH didn’t want to continue so we didn’t. A couple of months ago , he had another abdominal MRI. The lesion has now grown. PCP wanted to do a CAT scan. I said no. I know we would not treat lung cancer. But I wonder if it would be easier to keep him comfortable if we knew that he had cancer. Same questions you have. DH is in stage 5. I figure i can always change my mind and have him get a CAT scan. So I am choosing to not know at this point. If he becomes symptomatic, I’ll probably change my mind. Though if he does have lung cancer and it spreads, methods to keep him comfortable might not depend on the underlying disease. One day at a time.

trottingalong

my DH has had elevated psa tests and a biopsy. No cancer. He is stage 4/5 in the dementia journey. Recently his doctor asked him if he wanted an annual PSA test and he said no. He didn’t see the point in it. He’s 80 and aware he has memory and cognition problems. I would do what M1 suggested and leave it alone. Usually prostate cancer is slow growing the older you are.

Crkddy

https://alzconnected.org/discussion/70099/possible-cancer-diagnosis

jazzma, I was diagnosed with prostate cancer last year at age 64. My urologist said I could monitor or seek treatment. At my relatively young age, it was more likely that the normally slow growing prostate cancer would be a problem for me in later years. Therefore, I elected to have radiation treatment. The cancer is gone but I now have complications from radiation proctitis that I will likely be living with for many years.

I would be surprised if anyone can accurately predict whether prostate cancer or dementia will take your DH. There are just too many individual factors involved. Normally, prostate cancer is supposed to be slow growth, and we all know that dementia is a slow moving train wreck. Since you've already decided not to seek treatment for the cancer, all there is left to do is wait to see what happens. My heart goes out to you and your husband.

Maru

https://alzconnected.org/discussion/70099/possible-cancer-diagnosis

https://alzconnected.org/discussion/70099/possible-cancer-diagnosis

https://alzconnected.org/discussion/comment/217738#Comment_217738

https://alzconnected.org/discussion/70099/possible-cancer-diagnosis

Maru

My DH and I had a serious conversation soon after he got his diagonsis of Alz a couple of months ago. He is 89 and I am 84. We have had end of life discussions before and this just added another layer to that. According to the neurology tests, his executive function is on the edge of normal senior aging. He (we) decided that we would not do anything to extend his life such as cancer treatment and so on. His father lived to be almost 99 and he certainly could, as well. We will treat him for comfort as needed. I am sure that many before us have struggled with this kind of question. For younger people, I think the decision to treat or not treat is probably harder. I am sorry you have to make these decisions.

Jazzma

Update…the scan didn't show any obvious tumors, though it didn't get a good shot of the prostate. I'm not going to do anything else. My biggest concern is that he is losing weight quite rapidly. We will just keep on keeping on. Thank you all for your compassion and advice.

M1

Good decision I think, I would agree completely. The weight loss is concerning of course. If he starts to have pain, you treat it. I hope things go quietly…..