My husband is 83yrs old and has Alzheimer's. In February he had a small 0.5 cm bladder tumor removed with the following diagnosis: Carcinoma of the bladder with the following features 1)Tumor type: non-invasive carcinoma 2) Histologic type: Urothelial 3) Histologic grade (WHO/ISUP 2004): High grade 4) Tumor configuration: Papillary; 5)Extent of invasion:None identified; 6) Lymphatic invasion: Absent; 7) Associated epithelial lesions: None; 8) Muscularia propria (detrusor muscle): Not identified.
My husband had a very difficult time after the cystoscopy (when they discovered the tumor). He was pretty miserable to say the least with the burning & frequent urination and developed a urinary track infection to make matters worse. He couldn’t understand what was happening even though I would explain whenever he would ask. Then came the surgery, which went well, but he came home with a bad case of the flu along with the incontinence, etc. He didn’t want to take his pills and strongly resisted drinking water. Again, he had no understanding of what was happening to him or that he had even had surgery. He would ask “Is this the way my life is going to be??”
At the follow up visit to his doctor I was able to speak to the doctor prior to him seeing my husband. I wanted to make sure that he understood that my husband has dementia and didn’t even remember having surgery or why. I was concerned that if further treatment was needed if my husband would be able to tolerate the effects or if he would even be able to follow instructions. The short version of the doctor’s recommendation was to have a follow-up cystoscopy in 90days (May 18th) and to proceed with surgery if another tumor has appeared. That would be followed by a once a week treatment for 6 weeks with BCG that would require him to hold off urination for 1 hour. The doctor said without treatment there is a 30% chance of a recurrence and with treatment there is a 15% chance of recurrence.
The cancerous bladder tumor is most likely the result of receiving seed implants/radiation for prostate cancer 12 years ago. The tumor appeared in the location of the prostate to the bladder, where redness can still be seen. If there is a recurrence, it will probably be in this area and near to where he had the present tumor.
Generally, my husband is content and enjoys his days even though his activity is limited. Since the cystoscopy in January and surgery in February it’s only been the last couple of weeks that he is back to his usual self. It’s nice to see him smile again! I guess my question is, is it really worth putting him through further cystoscopies & perhaps surgery and BCG treatments? Are there stats as to treating someone in their 80’s or with dementia? I want his final days to be at home and for them to be as painless and comfortable as possible.