Am I too old to have prostate surgery?

Nancy Ferrari

Senior editor, Harvard Health

How old is too old to have a radical prostatectomy?

William D. DeWolf, M.D., Chief of the Division of Urology at Beth Israel Deaconess Medical Center, says:

For surgery to make sense — that is, for the benefits to outweigh the risks — you need to be young enough to take advantage of the added survival time that surgery can offer. That’s why I generally don’t recommend this surgery for a man whose life expectancy is less than 10 years, or for a man who is older than 75, depending on his personal and family health history.

Radical prostatectomy  is a major operation that can cause serious and life-threatening complications such as blood clots in the legs and lungs, abnormal heart rhythms, heart attack, pneumonia, and infections. The risk increases in older men and in those with other medical conditions, such as heart and lung disease, high blood pressure, diabetes, or a history of blood clots. Some studies have shown that side effects, namely urinary incontinence and erectile dysfunction, also increase with age.

Operating by remote control

Operating by remote control

Many physicians recommend a robotic prostatectomy, shown here, over traditional “open” surgery because the recovery is less taxing. But complications can still occur.

Because many prostate cancers grow so slowly, an older man with the disease may choose active surveillance, which involves following the cancer to see if it advances and causes symptoms. If it does, or if the man prefers to have immediate treatment, radiation therapy can control the disease for years. Hormone therapy can also help.

The bottom line: If your doctor says that you are too old for surgery, don’t despair. Other, less-risky treatments may hold the cancer in check. Talk with your doctor about the options.

SOURCES: Alibhai SM, Leach M, Tomlinson G, et al. Rethinking 30-Day Mortality Risk After Radical Prostatectomy. Urology 2006;68:1057–60. PMID: 17113897.

Thompson RH, Slezak JM, Webster WS, Lieber MM. Radical Prostatectomy for Octogenarians: How Old is Too Old? Urology 2006;68:1042–45. PMID: 17095073.

Originally published July 1, 2009; Last reviewed April 8, 2011

Comments:

  1. AmaroSaumell

    I find it very disconcerting that a man at 75 years old will be told that he cannot elect to have robotic surgery when I’ve known people in their 90’s who have had open heart surgery. A friend of mine has been told this for several years now, when he has no other health issues. His doctor when the route of hormone therapy, which worked for a while. He wants the prostate out BEFORE it can metastasize. He is willing to take the risk as he has witnessed bone cancer and does not want it to spread. The risk of the surgery seems to outweigh the risk of death through a spread of the cancer, especially when he is in good health and surgeries are performed on people in much worse condition. It sometiomes seems that doctors only want to do only their specialty!

  2. Araki Cherry

    My Dad is 76 years old is he needs a treatment surgery ,, because he had a stage 1 prostate cancer , what will we do , please give me advice, because his too old . thank you please reply me🙏🏻godbless.

  3. Al Ringelheim

    My urologist wanted me to have radiation I had done my research and told him I do not want the side effects of radiation that appear a year or so after treatment. He didn’t want to operate because i was at the time over 75. After he consulted my other Dr’s and I had an MRI and CT scan he performed the operation. I was able to get control within 2 months and I was using Viagra (didn’t help with the ed but kept the blood flow) I have since started using BiMix self injections. They work well and now 13 months after the operation I still have a 0 PSA I check every 3 months. and the BiMix works well. I even am starting to feel more like my old self. Don’t give up there are many treatments for this. Just make sure you get the Best Dr’s you can. Good luck to you all
    Al

  4. Nina

    Hi thulasibai
    My dad 80 is suffering from exactly the same problem ,presently on catheter but dr recommends surgery .me I do not want it since for now he is normal ,healthy and working around the house .pls let me know if you receive advise regarding surgery .
    Greatly appreciate your response
    All the best for your dad

  5. Arshad Jilani

    To add his PSA level is 7.

  6. Arshad Jilani

    Hi
    A relative of mine in India has prostate enlargement and UTI/Kidney infections. He is 83 years old. The doctor in India says that it would be treated with antibiotics for 6-months to cure. Do you think removal of prostate is a better option than antibiotics treatment?

  7. P THULASIBAI

    My father was suffering urinary problem due to prostate enlargement. He has not informed us. Due to this one kidney fully not working and one kidney only in half working condition. In this stage we consulted doctor. All the test he has undergone. Creatine level corssed 3.5 and HB is lower than 8. After he was living with cathetar and controlled food without salt and water. After three months he felt cathetar is very disturbed so he was used to suprapubic cathetar through bladder. He was comfort for the last two years. Now creatine level also comes to 1.8 and HB >10. Whether this result reflects the kidney working position? If so whether his two kidney is working? Whether prostate surgery is helpful For 80 years old man ? Now he is normal. What will be the post operation effect after prostate surgery. Please advise through my email.

  8. Sandy Reed

    I have noticed a light brown color in my semen. I am being treated for Pulmonary Embolism and am active and my shortness of breath is getting much better. I am taking Plavix AND Xarelto daily. will these medications cause this brown semen side effect?

  9. Corrine

    Please help my husbands erections are fleeting even with cialis (everyday pill). he had surgeon prostate surgery
    nerve sparing in 2011

  10. toreh Bahrami

    My fatter also 84 and doc suggests turn surgery for his prostate cancer that has grown in to his bladder and is blocking. Should he do this ? please advise

  11. jenelyn l. antonio

    my Father also is 92 years old. He is suffering his prostate also. from the start of this problem he is ill and last for one year after that due to a very active man again again he brought to hospital until now he suffered always the pain by changing his catheter and bags..the doctor offered him and operation. for me it is okey that he undergo operation by his age…my father due to suffer the pain he wants to have and operation but….?

  12. Dianne Hayter

    My dear father is 93-yrs-old, a very active man, preached in Florida last winter, plays badminton twice a week till 4-mos ago, when is 16-yrs.old Ca of Prostate prevented him from urinating. His PSA was 100, but with hormone therapy, went down to 40, 301, and now below 1 over the course of 4-mos. His bone scan, cat scan shows now metastasis. However, there were problems removing his catheter at times, as it has been a real hindrance in performing his daily interests. He has had many nurses daily changing catheters and bags, but I have talked him into managing this himself,( he was an RN from England and a pastor..)

    Today, his heart was set on the catheter being removed as it PSA level is below one, thought the specialist may, but sadly he was told he would have to live with it and not return to Florida as per usual the last twenty years, where he often preaches. He suffers now from fatigue, probably related to the hormonal Rx. The Dr. also told him to forget travelling to Florida, as he uninsurable(but this has not prevented them from going previously)! They belong to a strong Christian community there, where all their dear friends live.

    My question, as his daughter(also an RN) living quite a distance, is: ‘How is it determined that he needs the prostate scraped, and If it was necessary could it not be done under an epidural? The specialist said he could enter the prostate through the penis, but my father believes the physician does not want to do this for another reason. Dad had shingles twice and it was excruciating and thinks the Dr. does not want him to suffer, but I believe that’s my father’s choice.

    My father felt all hope gone, except for heaven; he has a strong spirit and loves God, and life and feels resigned to ‘have to live the remainder of his years attached to this tube (and changing bags). He is more lethargic possibly from the meds, and I am hoping as i would like to understand more fully whether there is an alternative.

    God bless you for allowing questions,
    Sincerely
    Dianne Hayter
    (formerly Morley)

    • Teresa E. Carpentero

      Hello ,Miss Dianemne. MY father also has benign prostatic hypertrophy,prostate cancer. His spa is 64 and I am strong enough to let him undergo transdermal resection of prostate. Will he survive after the surgery?

  13. Antonis Diomidous

    Hello,
    I have a total PSA of 2.66 and a year ago was 2.11, and my FPSA is 1.025 and a year ago was 0.81. My PSA ration seems to have remained quite stable at 38.5%. Last year after the results i was examined by a urologist and he told there was nothing to worry about. By the way I’m 56 years old and i have no other symptoms.
    Thank you
    Antonis

  14. Victoria Larkins (wife)

    What are the after effects of radiation for cancer that has just spread to the bladder in a 79 year old man who was first diagnosed at the age of 72? He has had laser surgery which removed half of the cancer in the bladder. Can he be O.K. with just hormone therapy and what are the disadvantages.

    Where can one view the answers to all of these questions?

  15. Dennis Donohoe

    I had a TURP operation ten weeks ago. I still have burning when I urinate. How long should I expect this to continue. If I exercise a lot I will get blood in the urine. Can I expect to have normal erections after this surgery? I still suffer from some incontinence. Can I expect this condition to get better and if so how long before it does? Thank you.

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