Is there really any "consensus view" for PCa treatment?

But it makes sense to my layman brain.  If the average life expectancy
for a US male is 75 +/- years, and the treatment cure prognoses for
surgery, EBRT and seeds are equal for 10 years, then surgery would be
the last choice for patients 65 years and above, given the physical
demands of surgery and the greater potential for incontinence and
impotence vs. lesser side effects for radiation.

"that surgery after the age of 65 does not make a lot of sense"

Well Fred, then there appears to be a significant portion of the PCa RP
community that has "Stopped Making Sense"!  A recent demographic study
(WHO IS THE AVERAGE PATIENT PRESENTING WITH PROSTATE CANCER?; UROLOGY
66 (Suppl 5A): 76-82, 2005; KIRSTEN L. GREENE, JANET E. COWAN,
MATTHEW R. COOPERBERG, MAXWELL V. MENG, JANEEN DUCHANE, AND PETER R.
CARROLL) of RP patients found the following

Demographic                    1997-1999, n (%)
2000-2003, n (%)
Age at diagnosis

<60                                     76 (23)
 590 (28)
60-70                               149 (46)
 893 (42)

...Ron

I think there might be a general consensus that the older you are, the
lesser able you will be to tolerate major surgery.  In all due defference to
Dr. Zerhouni (who quite possibly has little more remaining medical
qualifications than a 3M CEO), I know 50-year-olds who should not risk major
surgery and some 75-year-olds who could.

I'm not saying the surgery is always the preferred treatment, but you should
not second-guess your decision nor use 65 as a delimiter.

Fred quoted:

If the good doctor can make blanket statements, so can we: Untreated PC
kills in 15 years and the AVERAGE 65-year-old man is expected to live
15-16 years. Then tell it to the millions of men over 80, thousands of
whom are athletes and HALF of whom are expected to live past 88. At the
limit, tell it to Jack Lalanne.

Case by case, guys. If you are athletic, have old parents, and are
otherwise in good health, it's a pretty good guess that you're among the
half of 65-YOs likely to benefit from treatment, including surgery.

I.P.

...

Dr. Zerhouni is a very well respected former professor and researcher
with some 157 peer reviews scientific publications to his credit.  He's
a very, very, bright and knowledgeable guy.

Also (surprise!) he's a radiologist - though his specialty was
diagnostic
radiology rather than treatment.

It seems to me that flat statements about what is best for patients
should be treated only as general guidelines.  There are extremely
fit 65 year olds and very decrepit 50 years old.  So age is not a
perfect criterion for determining what treatment is best in many
cases.

Whatever the age consensus is, there is at least a general consensus
that, at some age, a patient is better off with radiation than surgery,
at some age he's better off with hormone therapy than radiation, and
at some age he's better off with no treatment at all.  However the age
cutoffs should probably be established by a doctor who examines
an individual patient rather than by reading an age chart.

   Alan

Dr. Zerhouni should be very careful about what he says in public.  It is
not age per se that is important but the health and expected lifetime of
the patient.   Some men at 75 still have a good 20 years ahead of them
and others at 60 would be lucky to last another 10 years.  The general
guideline that urologists have been using for years to decide whether or
not to treat early prostate cancer aggressively is an expected lifetime
of 10 or more years.  One other factor in deciding between surgery and
radiation is that it is very difficult for even the best surgeons to
prevent impotence in men over 70.  But again, this can depend quite a
lot on the specific man.  No urologist worth his salt makes decisions of
this kind based purely on the patient's age.

At age 66, my urologist recommended either surgery or radiation.  I
chose surgery, and I've come through okay, at least so far.  I have had
undetectable PSAs for 5 years, and after about 18 months I regained
erections.  Had I been 5 years older at the time, I probably would have
chosen radiation because of the somewhat lower risk of impotence and a
lower expected lifetime in which the cancer could recur.

Certainly, anyone considering treatment should discuss all his options
with his urologist and understand all the odds as they apply to him in
particular.  I would hope that is standard practice.  It certainly was
in my case.