What is treatment for Gleason Score 8 at 80 years old in good health?

It's really up to you. You can put up with some discomfort and difficult side-effects now in the hope of seeing your 90s (and maybe beyond) in good enough health to enjoy them, or stick with milder care now so that you have the energy to make the most of your early 80s, when you *know* you're still fit and mobile.

The important thing is not to let your healthcare team make assumptions based just on your age. This is *your* choice, and if you're absolutely clear (and stubbornly persistent) about what you want, they should follow your wishes as much as medically possible.

(For me, the choice was easier: I was 56 in 2021 with a de-novo stage 4 prostate cancer diagnosis and paraplegia from a tumour compressing my spine. I had a lot of years to lose and my mobility to try to regain, so I told them I wanted to fight like hell, and reminded them at every opportunity: they promised to "throw the kitchen sink at it," and so far it's working.)

My brother at 77 had Five sessions of SBRT radiation and he’s now 80 and doing fine.

Has it spread beyond the prostate? Is your PSA over 20? Those could require ADT as could the things listed just below. I’m 78 and I’ve been on ADT for eight years. It affects people differently, Some get a lot of fatigue I’ve never had any.

Were any of these things found in the biopsy intraductal, cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive. This would require more sessions of SBRT or IMRT and maybe even I follow up with brachytherapy.

effmarcjnagrock effmarc
Thanks for your reply! Although agressive, it is still contained in the prostrate. Have an appointment in one week with urologist to hear his advice.

@northoftheborder
Thanks for your suggestions. I will...

sodogo, you want to see a surgical oncologist and a radiation oncologist. I would suggest radiation the five fraction, because it is little inconvenience for the advantage. This because the cancer is contained in the prostate. The discomfort of cancer to the bone an other painful inconveniences would make the five session especially attractive. I was surprised to find out that radiation is painless. I'd be thinking of quality of life with cancer, as well as longevity. You have good health, I think you should keep it.
Bless your choice.

My oldest brother (79y) was treated for 7(4+3) last year with 28 sessions of IMRT + 2 years of Eligard.

(At 65y, I was treated for 7(4+3) in 2021 with 28 sessions of proton radiation + 6 months of Eligard,)

For a Gleason 8 (high risk), NCCN guidelines recommend (see attached).

The quality-of-life you desire plays a major role in the treatment decision.

@gently
please explain the radiation the five fraction and painless
Thanks

"Fraction" is basically the number of visits you make for radiation therapy (excluding the simulation beforehand). "Painless" describes the experience *during* radiation, but some people experience pain a few weeks afterwards (in most cases it is mild and disappears quickly, but not always).

@brianjarvis
Thanks, will check it out.

@northoftheborder
Thanks!