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

Thanks for replying and suggestions. PET Scan Gleason score 8 contained in prostrate although aggressive. No history since father died wirh ALS at 39 and brother and grandparents early with heart issues. So I'm plowing new. Meet urologist Wednesday probably be given option surgery or radiation. Thanks

I was diagnosed with Prostate cancer a few days before my 90th birthday. Like yours, mine is a Gleason 4+4 = 8. I also have cribriform glands in one of the cancerous cores.

I received radiation therapy when I was 91, 28 sessions of Intensity Modulated Radiation Therapy (IMRT). The PSA fell rapidly after the radiation started. Now, at 8 months after the radiation therapy, the PSA is 95% below what it was before the radiation started.

I have some minor side effects, there is more frequent urination, minor urine leakage, and a mild case of proctitis. No fatigue. You can expect any cancer treatment to have side effects. The alternative is a shorter life. I believe the side effects of radiation are less than those of a prostatectomy.

Thanks, good to hear from someone older! You hav3 definitely given me something to think about.

@overage I should add the Gleason 8 is high risk cancer and the Standard of Care for that with radiation is 12 to 36 months of ADT, or Chemical Castration for short. The addition of the ADT has been proven in trials to improve the long term outcome of the radiation. The side effects of the ADT are a decrease in bone density and high cholesterol and glucose levels as well as a loss of sexual function, hot flashes and perhaps mood changes and some brain fog..

I have the hot flashes and the sexual effects, although at 90-plus that part is minor. The side effects that concern me are bone-related, cholesterol, and glucose.

I was given an oral medication for bone density and then switched to an injection every 6 months (Prolia) which is more effective in raising bone density. The Cholesterol problem was solved with a statin plus ezetimibe which reduced my cholesterol from 240 to less that 140 within 60 days. The glucose is being partially controlled with metformin a relatively cheap medication commonly used for diabetes .

@jeffmarc

Jeff, thanks for your strong commitment to monitor this forum and help men with P.C. You do an excellent job of it.

My comment you question was a poorly worded statement by me. What I meant to say was that the side effect profile from long term beam radiation seems to shift the side effect events out to a longer term as well, as compared to the short term SBRT radiation group. At least that is my take on it after doing much study. When I use AI and ask a question comparing the two groups it seems to bear this out. Here are two screen shots from my research.

As example, here is a YouTube vid about Jerry, a man that did long term proton radiation and developed radiation proctitis 18 months after treatment.

@brianjarvis

Brian, you did an excellent job of researching and selecting treatment! I tried as well. Time will tell, for both of us. I live at the edge of the world, so to speak, so I had to relocate for two weeks,
Leave wife at home alone in a very rural area to take care of the farm. I just couldn’t do that to her for six weeks or more.

@oldgreenpaint
Here’s some more information about Long-term and short term side effects that was posted by a doctor in one of the recent conferences.

Proton radiation therapy would be the best option if "radiation" is included in your decision matrix. i had proton radiation in 2010 at Loma Linda Medical (near Riverside, California). Absolutely, no issues post radiation. Mayo Clinic in Jacksonville, Florida would be the best choice for diagnostic analysis. The adjoining University of Florida with their proton radiation devices are next door or near Mayo Clinic. There are others in the US, and only one I know of in Europe (Heidelberg, Germany). This, of course depends on the financial metrics of insurance, etc. There is also what is call watchful waiting...all depends on the condition of the patient and the numbers relative to the cancer condition (PSA, MRI results, PET scan results, etc).

@oldgreenpaint You gotta watch that AI. Indeed, your summaries make it look like IMRT will be more likely to have long term SE’s - compared to SBRT, for which it characterizes long term SE’s as ‘rarely’…
The bottom line is that either one ‘can’ give short and long term SE’s in different individuals under different circumstances.
Also remember that AI is a compilation of snippets culled from the internet and doesn’t always discriminate when it comes to the fine print.
Phil