Question

85 year with Ca prostate with Gleason 6 and PSA < 8 ng/ml. Best management?

• A. TURP
• B. Radiation
• C. Radical prostatectomy
• D. Keep on active surveillance

Answer 1

The Correct Option is D

To determine the best management for an 85-year-old patient with prostate cancer, a Gleason score of 6, and a PSA level of less than 8 ng/ml, we should consider several factors:

1. Patient Age and Life Expectancy: At 85 years, the patient's life expectancy is an important consideration. Prostate cancer with a Gleason score of 6 is generally considered low grade and slow-growing, implying that the patient might not experience significant progression within his remaining years.
2. Cancer Characteristics: A Gleason score of 6 is often categorized as low-risk prostate cancer. Along with a PSA level of less than 8 ng/ml, the cancer is not aggressive and less likely to spread rapidly.
3. Risks and Benefits of Treatment Options: Considering the patient's age and the low risk of progression, invasive treatments like radical prostatectomy or radiation therapy may carry more risk and side effects than benefits. These treatments can adversely affect the patient’s quality of life, especially given potential complications.
4. Active Surveillance: This approach involves regular monitoring of the prostate cancer via PSA tests, digital rectal exams, and possibly periodic biopsies. It is the most suitable option here as it avoids unnecessary treatment in an elderly patient with low-risk cancer.

Conclusively, given the patient's advanced age, the low-risk nature of the prostate cancer, and the intent to maintain quality of life, the best management strategy is active surveillance. This option allows for monitoring the disease while avoiding overtreatment and its associated complications.