Sunday, September 25, 2022

Prostate Surgery After Age 70

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Prostate Cancer After Age 70

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It now looks like theres another age-related threat for men over age 70: prostate cancer . A recent paper out of Cleveland Clinic analyzed the diagnostic and follow-up records of 2018 prostatectomy patients older than 70. The research team collected data on patients preoperative clinical factors, extraprostatic extension , and postoperative features . They then calculated the statistical association between these factors and biochemical failure . For comparison, they did a parallel analysis of matched patients ages 50-70 with similar PCa features to determine the effect of age on treatment failure.

Your Cancer Treatment Goals

Your cancer treatment goals depend on many factors. For example, the type of cancer and whether it has spread will factor into your goals.

Treatment goals include:

  • Living longer, even with cancer

  • Having fewer symptoms from cancer and side effects from its treatment

  • Maintaining physical and emotional strength

  • Having a certain quality of life

Your goals might be different from a younger persons. For example, a healthy younger person’s goal might be to cure the cancer even if treatment is very difficult. Some people are able to have aggressive treatment. This might not be true for you.

Depending on your age and general health, you might care more about feeling well than curing cancer permanently. This might be especially true if you have a chronic health condition or you feel that your quality of life is poor.

But if you are very healthy and enjoy many activities, you might want aggressive treatment. You might have plans many years in the future. If so, you might want your health care team to do everything possible for a cure.

Prostate Cancer Surgery Complications More Likely Among Older Men

Prostate cancer patients aged 70 years and older who undergo radical prostatectomy experience significantly higher rates of perioperative morbidity than those younger than 60 years, according to a new study.

The study, which included 35,968 men aged 18 to 89 years who underwent RP from 2010 to 2015 in the National Surgical Quality Improvement Program database, found that the perioperative blood transfusions rates were 6.0% among patients aged 70 to 89 years compared with 3.7% among those younger than 60 years, a team led by Boris Gershman, MD, of The Miriam Hospital and Brown University in Providence, Rhode Island, reported in Urologic Oncology. The older group also had higher rates of 30-day complications , readmissions , and 30-day mortality . The most common complications overall were infectious complications , followed by surgical site infection/wound complications , and thromboembolic complications .

In multivariable analyses, patients aged 70 to 89 years had a significant 31% increased risk of any complication, 39% increased risk of requiring a blood transfusion, and 2.7-fold increased risk of 30-day mortality, according to the investigators.

These results have implications for preoperative risk-stratification and counseling given potential for increased utilization of surgery as definitive local therapy for older men, the authors wrote. Moreover, they identify patients for whom perioperative interventions may reduce morbidity.

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What Causes Prostate Cancer

Experts arent sure why some cells in the prostate gland become cancerous . Genetics appear to play a role. For example:

  • Youre two to three times more likely to get prostate cancer if your father, brother or son has the disease.
  • Inherited mutated breast cancer genes and other gene mutations contribute to a small number of prostate cancers.

Risks Of Prostate Surgery

Temporary Perineal Urethrostomy During Holmium Laser Enucleation of the ...

The risks with any type of radical prostatectomy are much like those of any major surgery. Problems during or shortly after the operation can include:

  • Reactions to anesthesia
  • Blood clots in the legs or lungs
  • Damage to nearby organs
  • Infections at the surgery site.

Rarely, part of the intestine might be injured during surgery, which could lead to infections in the abdomen and might require more surgery to fix. Injuries to the intestines are more common with laparoscopic and robotic surgeries than with the open approach.

If lymph nodes are removed, a collection of lymph fluid can form and may need to be drained.

In extremely rare cases, a man can die because of complications of this operation. Your risk depends, in part, on your overall health, your age, and the skill of your surgical team.

Also Check: Prostate Cancer Recurrence Survival Rates

Radical Prostatectomy Retropubic Or Suprapubic Approach

  • You’ll be positioned on the operating table, lying on your back.

  • An incision will be made from below the navel to the pubic region.

  • The doctor will usually perform a lymph node dissection first. The nerve bundles will be released carefully from the prostate gland and the urethra will be identified. The seminal vesicles may also be removed if necessary.

  • The prostate gland will be removed.

  • A drain will be inserted, usually in the right lower area of the incision.

  • What Is The Prostate

    The prostate is a small gland in men that helps make semen. Located just below the bladder in front of the rectum, it wraps around the tube that carries urine and semen out of the body. It tends to grow larger as you get older. If your prostate gets too large, it can cause a number of health issues.

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    Dealing With Prostate Cancer

    Being diagnosed and living with prostate cancer can change how you feel about life. If you or your loved one is dealing with prostate cancer you may feel scared, stressed or even angry. There is no right way to feel and everyone reacts differently.

    Visit our wellbeing hub for information to help support you in looking after your emotional, mental, and physical wellbeing. If you are close to someone with prostate cancer, find out more about how you can support someone with prostate cancer and where to get more information.

    Prostate Cancer: A Guide For Aging Men

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    Prostate cancer is one of the most frequently diagnosed cancers in the world, despite it only being diagnosed in males . In fact, more than 70 percent of men over the age of 80 have some quantity of cancer cells in their prostate.

    Its so common that it sometimes doesnt go diagnosed until autopsies are performed, though that doesnt mean the cancer is the cause of death. On the contrary, the overall prognosis for men diagnosed with prostate cancer is as positive as you can get when talking about the dreaded c word. The five-year survival rates for the disease are close to 100 percent, especially when talking about prostate cancer that is caught early on in the processbefore it spreads.

    The five-year survival rates for the disease are close to 100 percent, especially when talking about prostate cancer that is caught early on in the processbefore it spreads.

    Nevertheless, prostate cancer is serious business, and the best way to handle a diagnosis is to be informed. Lets take a look at the frequency at which its diagnosed, how youre tested for it, how it can affect your daily life, and what we can do to try and prevent the disease.

    Average Age of Prostate Cancer Diagnosis

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    When You Meet With Patients Who Have Opted For Prostate Cancer Surgery What Complications Seem To Cause The Most Anxiety

    Patients are usually concerned about longer-term quality-of-life issues, such as urinary control also called urinary continence and changes in sexual function. Prostate cancer surgery does sometimes have a negative impact on these functions, although the likelihood depends on a variety of factors, including age, the extent of the cancer, and baseline function, or how well everything worked before the procedure.

    The outcomes for urinary continence at MSK are what I would consider to be excellent. More than 90 percent of our patients will regain urinary control, although they may go through a period perhaps several months or a year after surgery in which they do not have complete control.

    For sexual function, the extent of recovery is especially affected by the nature of the cancer. Unfortunately, the nerve tissue that allows a man to get an erection is right up against the prostate. We obviously want to remove all the disease, and if the cancer extends outside the prostate at all, its not wise for us to try to preserve the nerve tissue because we might leave some cancer behind.

    You often see claims made by institutions or surgeons that the patients they treat recover their erectile function in 90 percent of cases. Thats true only for a very select group of patients, usually those who are younger and had full erections prior to surgery.

    Questions To Ask Your Doctor Or Nurse

    You may find it helpful to keep a note of any questions you have to take to your next appointment.

    • What type of surgery do you recommend for me and why?
    • What type of surgery do you recommend for me? Will you try to do nerve-sparing surgery?
    • How many of these operations have you done and how many do you do each year?
    • Can I see the results of radical prostatectomies youve carried out?
    • What pain relief will I get after the operation?
    • How and when will we know whether the operation has removed all of the cancer?
    • How often will my PSA level be checked?
    • What is the chance of needing further treatment after surgery?
    • What is the risk of having urinary problems or erection problems and what support can you offer me?

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    Questions To Ask The Health Care Team

    After you learn about your treatment options and your general health, you might need more information. Consider asking your health care team the following:

    • Is my cancer curable?

    • What is my chance of recovery?

    • What are all of my treatment options?

    • What is the goal of each treatment?

    • What treatment do you recommend? Why?

    • How does this treatment help me?

    • What are some risks and potential side effects of this treatment?

    • Will I need to be in the hospital for treatment? Or can I stay home and come to the hospital or clinic during the day?

    • How long will each treatment last?

    • How will this treatment affect my daily life? Will I be able to perform my usual activities?

    • If I am worried about managing the costs related to my cancer care, who can help me with these concerns?

    • How can I keep myself as healthy as possible during treatment?

    • If I have questions or problems, who should I call?

    • What support services are available to my family?

    When Is It Time To Stop Being Checked For Prostate Cancer

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    Image: Thinkstock

    Its essential to be fully informed about the potential risks of PSA testing, which includecomplications from biopsies and teratments.

    The answer depends on your current health and your level of concern about cancer.

    Routine PSA testing to check for prostate cancer is no longer recommended for most men. But despite what the experts suggest, many men continue to opt for annual PSA tests. This includes a surprisingly large number of men in their 70s. In a recent study in the journal Cancer, more than half of a group of men 75 and older had PSA tests and biopsies.

    These men have placed their hope in the value of early diagnosis and treatment, yet stand to gain less from PSA testing than younger men. Across all ages, routine PSA screening leads to life-saving treatment for cancer in about one in every 1,000 men screened.

    Force guidelines: These independent experts on preventive medicine do not recommend PSA screening for prostate cancer in men at any age, due to a lack of definitive evidence that the benefits of PSA testing are greater than the risks.

    Read Also: Can You Get Prostate Cancer From Masturbating

    Good Prostate Cancer Care

    Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.

    You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.

    You should also be told about any clinical trials you may be eligible for.

    If you have side effects from treatment, you should be referred to specialist services to help stop or ease these side effects.

    Some Things To Consider When Choosing Among Treatments

    Before deciding on treatment, here are some questions you may want to ask yourself:

    • Are you the type of person who needs to do something about your cancer, even if it might result in serious side effects?
    • Would you be comfortable with watchful waiting or active surveillance, even if it means you might have more anxiety and need more frequent follow-up appointments in the future?
    • Do you need to know right away whether your doctor was able to get all of the cancer out ? Or are you comfortable with not knowing the results of treatment for a while if it means not having to have surgery?
    • Do you prefer to go with the newest technology , which might have some advantages? Or do you prefer to go with better proven treatments that doctors might have more experience with?
    • Which potential treatment side effects might be most distressing to you?
    • How important for you are issues like the amount of time spent in treatment or recovery?
    • If your initial treatment is not successful, what would your options be at that point?

    Many men find it very stressful to have to choose between treatment options, and are very fearful they will choose the âwrongâ one. In many cases, there is no single best option, so itâs important to take your time and decide which option is right for you.

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    What Typically Increases The Risk Of Complications From Prostate Cancer Surgery

    Complication risks can be increased if prior surgery for unrelated reasons was done in the area or if we have to do extensive surgery to remove the cancer. But complication rates also go up dramatically when we do surgery on patients who have failed other prostate cancer treatments, such as radiation therapy.

    Radiation is a very effective treatment for prostate cancer, but it doesnt work for everyone. In these patients, we often believe the cancer has recurred or persisted in the prostate without spreading, so removing the prostate following failed radiation treatment a procedure called salvage prostatectomy is potentially curative.

    Salvage prostatectomy is more technically challenging than radical prostatectomy. Patients who have already had radiation therapy often have scarring in and around the prostate, which can make tissue in the area very difficult to separate while performing the operation. As a result, patients undergoing salvage prostatectomy have a much higher risk of urinary incontinence, and a higher rate of developing more scar tissue, strictures which is a narrowing of the urethra that blocks urine flow or injury to adjacent structures like the rectum.

    Preventing The Fear Factor

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    I have written many blogs on lifestyle factors that experts consider worthwhile for reducing PCa risk: diet, exercise, stress management, and a supportive social network with positive family/friend relationships. In fact, an interesting longevity study demonstrated that modifiable lifestyle factors can help men over age 70 live to an even riper old age with good health.

    The 2008 study was titled Exceptional longevity in men: modifiable factors associated with survival and function to age 90 years. The research team used data from the Physicians Health Study . These were records on 2357 healthy men, average age 72 at the time of their enrollment. Based on their baseline physical health and lifestyle compared with their self-report and medical records 16 years later, 41% survived to at least age 90! The study showed that

    a 70-year-old man has a 54% chance of reaching the age of 90 if he does not smoke or have diabetes, has healthy weight and blood pressure, and exercises. But cutting out exercise and becoming more sedentary reduces the chances of reaching 90 to 44%. The chances dropped further with high blood pressure , obesity and smoking . Any three of these cut the chances of living to 90 to 14%.

    NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

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    Considering Prostate Cancer Treatment Options

    For most men diagnosed with prostate cancer, the cancer is found while it’s still at an early stage — it’s small and has not spread beyond the prostate gland. These men often have several treatment options to consider.

    Not every man with prostate cancer needs to be treated right away. If you have early-stage prostate cancer, there are many factors such as your age and general health, and the likelihood that the cancer will cause problems for you to consider before deciding what to do. You should also think about the possible side effects of treatment and how likely they are to bother you. Some men, for example, may want to avoid possible side effects such as incontinence or erection problems for as long as possible. Other men are less concerned about these side effects and more concerned about removing or destroying the cancer.

    If you’re older or have other serious health problems and your cancer is slow growing , you might find it helpful to think of prostate cancer as a chronic disease that will probably not lead to your death but may cause symptoms you want to avoid. You may think more about watchful waiting or active surveillance, and less about treatments that are likely to cause major side effects, such as radiation and surgery. Of course, age itself is not necessarily the best reason for your choice. Many men are in good mental and physical shape at age 70, while some younger men may not be as healthy.

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