Possible cancer diagnosis

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.

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.

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, 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.

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.

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.

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…..