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

@northoftheborder
I didn't know that people experienced pain weeks later. Thanks for a important correction.

@gently Most people who get radiation treatment to the prostate don't experience pain later, and those who do usually get over it quickly.

Even for the small minority who don't get over it (I have long-term mild radiation cystitis and proctitis), it's not that bad, and you get used to it. It does add a little excitement to spicy-food night, though. 😕

Although age is a factor in making treatment decisions - the most important one is the chance of recurrence in YOUR lifetime.
Younger men in their 50’s or 60’s with your aggressive Gleason score may opt for surgery since the chance for recurrence is greater in their longer anticipated lifespans. Because of this, recurrent cancer can then be treated with radiation and/or ADT.
In your case, being 80 years old and in excellent health, you have a good chance of living 10 yrs or more; the 10-15 year outcomes (successes AND failures) for surgery and radiation are the same.
That being said, you may opt for the lesser invasive treatment, which is the 5 fractions of radiation (cyberknife) mentioned by others since you are not looking at a 20+ year lifespan (just being realistic, nothing more)
Also be aware that you may be advised on a short course of ADT to weaken the aggressive cells further. You really need a Decipher Test to show the true aggressiveness of your cancer - Gleason 8 is a measurement of relative amounts of aggressive cells; more of the worse ones!
Decipher is the test to see HOW ‘worse’ they are…if more aggressive, short term ADT may be prescribed.
There is also a ‘boost’ radiation therapy which involves temporarily placing a powerful radiation source inside the prostate itself for about an hour (under sedation). This ‘boost’ called HDR brachytherapy is usually followed by conventional radiation of 4-5 sessions (cyberknife type) or IMRT, 25 or more sessions administered to the prostate and pelvic nodes.
From my post I think you realize that there are many gray areas here; it’s not simply surgery OR radiation.
I suggest you go to a hospital or center with a well known, skilled cancer team. Their radiation oncologists will be able to assess what is best for YOU, since (here it comes, guys) we are ALL different! Best,
Phil

@heavyphil
Wow! Thanks so much. You have given me a lot of excellent information and some good options to think and pray about.
Thanks!

@gently

Radiation is most definitely not always painless. I did 5 fractions of proton sbrt and urinary discomfort started at second treatment and escalated a bunch, so much so that I discussed with radiation team the possibility of pausing after the fourth treatment. Didn’t do it. Oncology nurse recommended 600mg advil 3 times daily, 1000mg Tylenol between the advil, AZO for a couple weeks, and flowmax.

I am now 8 weeks post treatment and off of all meds except a flowmax every third day, and two advil at bedtime. If I stop flowmax completely, I have poor urinary capabilities. Radiation can hurt you. Just about anything in prostate world can hurt you.

I think Prostox from Miradx has a mouth swab test to help determine radiation suitability . I learned too late on this one😒

@oldgreenpaint What you experienced is known - with the higher dose per fraction of SBRT, the risk of urinary bother is higher. (That is why I didn’t use proton SBRT; I had 28 sessions of proton radiation at 2.5 Grays per session).

Dr. Rossi talks about this in his portion of the 2023 Mid-Year PCRI presentation (https://www.youtube.com/live/WTqPnSRYtW4), starting at about timestamp 4:30:45.

These days they can even “cool” the radiation as they approach tissues/organs at risk if desired.

@brianjarvis

For sure, it is known, and I knew going into it my risks. Recollection is that bowels were 1-2% and urinary side effects were at 10-20%. But I think it is probably higher. Seems like it is also thought that 5 treatment radiation yields its side effects early on, while the 25-40 session treatments can happen years later. But like I said before, there is not very much that is certain and absolute in the PC world.

I just didn’t want to tie up 6 weeks of my life doing radiation. I still believe I made the right choice for me, but I can say for sure the two weeks of treatment and the two to four weeks following were a difficult time, and without support from radiation oncologist nurse, would have been REALLY difficult. She knew her stuff and how to medicate to a comfort level endurable.

Liked your video. Always learn something from pcri vids. Here is a link to Mayo info on proton SBRT
https://www.mayoclinic.org/diseases-conditions/prostate-cancer/in-depth/sbrt-for-prostate-cancer/art-20592262

@oldgreenpaint One benefit I had being retired at the time I was treated, was that incorporating a 40-minute drive (to the proton center) there and back was easy to incorporate into my daily schedule. So, I simply incorporated that drive into my trip to the gym (since I exercised 6 days/week). My wife later told me that if she hadn’t known I was undergoing radiation treatments, she wouldn’t have realized it from any change in me. And the short amount of time that I was gone each day for treatment were no different than any other time when I simply left to go shopping or to the gym.

With my treatment planning, we researched available literature, data from clinical trials, and my ROs experience, to come up with a list of short-, medium-, and long-term possible side-effects (See attached graphic.), and ways to avoid/minimize each.

As for the side-effects happening “sooner or later,” one thing is certain - what radiation doesn’t hit, won’t experience side-effects. So, the #1 goal is to not overshoot the prostate. (With its Bragg-Peak characteristics, that was one reason that I picked proton.)

I have no expectations of adverse side-effects in the future, and whether or not there will be a recurrence, we’ll see…… So far, approaching the 5-year mark my numbers are still good.

That’s good info on proton and SBRT. Lots of good info for others who are deciding on treatments to use.

There are only 47 active proton centers in the U.S. The vast majority of them are east of the Mississippi River: https://www.proton-therapy.org/map/

@oldgreenpaint
I was running a computer consulting business full-time when I had my 8+ weeks of IMRT radiation.

I had my radiation done at 8:30 in the morning and went to my client’s offices right after that. No one even noticed I was starting in the morning a little later, I usually could get to clients offices around 9:15.

I am not sure what you mean by this comment “ while the 25-40 session treatments can happen years later.”. After having proton salvage radiation, you could not have that 25 to 40 session treatments years later, because you would already have had a lifetime of radiation in that area.

We all need more information:
1) Did you have a Pet Scan with Gallium-68 tracer to see if the cancer is still confined to the prostate only, or if it spread?
2) If you had the PET Scan, was it in fact contained in the prostate, or did radioactive tracer show up in one or more lymph nodes? That will really drive a lot of your decision, depending on how long you want to live.
3) What is the longevity of males on both sides of your family, and did they have prostate cancer?
4) Of those family members who had prostate cancer, how long did they live "with it" or "after" they had the prostatectomy? Familial history is important. My dad lived to 99 years 10 months "with" prostate cancer that he likely had for 15-20 years at least. He never had the prostatectomy, but he did suffer his last five years with "MONTHLY" UTI's. My maternal grandfather lived to 96 "with" prostate cancer. He had Lupron injections for 15-20 years, but he lived to a nice old age. My maternal uncle lived to 86 and he "HAD" the radical prostatectomy, but died of a cluster-bomb massive stroke. All of those genetics and life choices come into play.
5) The bottom line most important question for all of the above, is that still being in good health, how long do you want to live? You are already 80. Prostate cancer grows slowly, but your Decipher Test Score (did you get a Decipher Test on your biopsied tissue?) reflect genetics as to your specific prostate cancer and your risk of mortality in 5, 10, and 15 years with standard therapy? And being a "healthy" 80 years old, you should survive and handle the surigcal procedure well enough to have a good outcome. The choice is yours! Good luck