Male Breast Cancer

[JTIDS]

Father is 80 years of age, and was diagnosed with:
"Invasive ductal carcinomo, nottingham grade 2.  Focally extends to lateral margins of resection.  Microscopic focus of intraductal carcinoma with microcalcification is noted.  Immunostains for estrogen and progesterone receptors are positive.  Immunostain for HER2/neu is negative (1+membranous staining.  Tumor measures 2 cm in greatest dimension in the submitted material."

He is diabetic (oral meds). Had a coronary about 18 years ago; can't recall meds for blood pressure and beta-blocker.  Severe arthritis in neck, back, knees; working through various pain-management options, with little success.  No feeling in feet and hands, and little fine-motor control; difficulty eating. Welbutrin is prescribed for depression.  Aricept has helped slow memory loss.  Not active, other than "scooter" outside.  Can still care for himself.  I don't have full accounting of prescription meds, but they are tedious for him.

Am concerned that he will not tolerate chemo treatments, and perhaps not radiation.  My research indicates that chemo is the norm, augmented with endocrine therapy.  
My question concerns the advisability of endocrine therapy only, vs. devastating effects of chemo.  His quality of life, now, is such that he is barely mobile; I'm afraid the chemo will de-mobilize him, and depression will take further toll.  I've been unable to determine if it is possible to declare this particular cancer agressive or non-agressive or re-gressive, based upon method of treatment.  Can you advise?

[ritavv]

I know a male breast cancer survivor that runs a website that you might want to check out.  There are so few resources for men.  This fine gentleman is in his 60s and would be happy to talk if you just need someone to understand.  Go to:
http://www.heartwarmers4u.com/members/?onein100

[surgeon]

I assume he's just had a biopsy or lump excision so far. If he can tolerate it, removal of the entire breast, and sampling of lymph nodes under the arm would be done. And given the fact that the tumor is sensitive to hormones, it might be that hormone treatment alone would be considered, which would be pretty easy to tolerate. "Standard" treatment may be modified when the patient's overall condition dictates it: options might include doing nothing more; or to do no more surgery but place him on hormone-blocking drugs; or re-operating to be sure margins are clear and do nothing more; or do some combination of the above along with hormone therapy; or, if the most aggressive treatment were chosen, mastectomy and chemotherapy. Sometimes it's best to aim for local control only. Such decisions need to be made with thorough and candid discussions with all involved.

[CCF-RN,MSN-rf]

Dear JTIDS:  In this situation, the first consideration would be if additional surgery is appropriate.  If not, then radiation would most certainly be recommended for local control.  Standard of care would be chemotherapy, radiation therapy and hormone therapy.  However, as with all of medicine, a person's condition must be considered when contemplating any intervention.  In discussion with the oncologist, the risks and benefits of any and all options should be discussed.  Ultimately, the decision is his (with input from those who love him).  Most doctors will not recommend treatment they feel will make life worse.