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

@jeffmarc

My urologist seems determined to only follow standard and well-established guidelines which means radiation treatment followed by 18 months or more of Lupron. Hopefully my PSA will remain low enough that I will not need any further treatment. I cannot risk another round of Lupron.

@pesquallie
If you have a reoccurrence that requires radiation, then you do not want to work with a urologist anymore. You want to get yourself a Genito urinary oncologist, The ones that specialize in prostate cancer. They will be more willing to modify the requirements to what you really need. There is no fixed rule, There are recommendations, which can be modified.

You need to be proactive if you have future issues, Tell them what you want. The reason I am on Darolutamide Is because I told my oncologist I wanted that instead of a PARP inhibitor. She had no problem with doing that. After starting me on the PARP, and my saying I wanted a change five days after starting it, I was switched to Darolutamide. If I had not spoken up, nothing would’ve changed.

Thanks for the advice. I have a brother who is a retired epidemiologist and a niece who is a senior pharmaceutical researcher on pancreatic cancer. My brother told me to listen to my urologist, but I agree with you and will seek new help if needed.

What type of radiation and hormone therapy would you suggest for a 80 year with a Gleason Score 8 contained to prostrate, particularly the hormone blockade, since that can potentially be devastating both physically and emotionally.

Without knowing a lot more about your specific case, it really is impossible to recommend a lot. .

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. That can really change the requirement that ADT is essential.

I am 78 and have been on ADT for eight years. I lead a pretty normal life, you would never know I have had prostate cancer for 16 years. Because of ADT, I run a mile on the track twice a day and go to the gym three times a week. Exercise is very important to offset the fatigue, Muscle and bone damage ADT can cause.

Whether or not an 80 year-old Can handle ADT is an unknown. For a short time, it might Not being a major issue. For some people, it could be a real problem. I know 80+-year-olds who are on Nubeqa alone. It doesn’t have much in the way of side effects And works, even when there is testosterone since it blocks its ability to let the cancer grow. Do you need to speak to your doctor and find out whether or not your health is good enough to handle ADT, Or maybe another option.

I can only comment on what happened to me. I had a Gleason9 contained in the prostate. PET scan revealed no spread outside. My urologist suggested photon radiation and ADT (Lupron and Zytiga with prednisone) stating that given my age (74) surgery had a high chance of my becoming incontinent. So, rather than the chance of wearing diapers the rest of my life, I did as she suggested. So far so good. ( 2+years). Best to you on your continuing journey…

My case - Gleason 8-9, contained. I'm 80+. Too old for surgery. They suggest Eligard for 2 years plus 20 EBRT fractions. I've done the radiation and am now 1 year into ADT. PSA is currently undetectable. It was 12 at the start. We'll see .....

I forgot to comment on radiation issues. Others have given you some really great ideas. Proton radiation would be useful, The photon radiation is pretty close in side effects and also works well.

My brother at 77 had SBRT radiation and at 80 is doing quite well. That is the preferred technique for somebody your age. Either SBRT or IMRT radiation can take care of the problem. Either of those usually causes some urinary issues, but they can be resolved with Flomax for most people.

If I had a significant other, I would have a very serious conversation with them and with the oncologist regarding my life goals: longevity vs. quality of life. How long do you want to live and how well? Hormone therapy means living at least temporarily with virtually no testosterone, typically with symptoms similar to women's menopause and loss of sexual function and desire. Both hormone therapy and radiation cause fatigue and radiation often causes digestive issues. Diagnosed at 73, my longevity goal has been to reach 80 without prostate cancer being the cause of death (I have plenty of other possibilities). I'm 74 and have received 44 radiation treatments and am in month 14 of 18 for hormone therapy, so by this time next year we should know whether my testosterone will return and I have whatever my new normal life will be. Be diligent to ask questions, don't rush, think long term. All decisions have consequences, so pick your poison well. 🙂 And we'll be here to support you.

I think this is your second post regarding your treatment; so you’ve ruled out surgery - a big first step.
Now you and your RO can decide on what type of radiation: IMRT - multiple sessions of (20-39) low dose therapy.
SBRT - 5 sessions of high dose therapy
HDR - a boost of very high dose (via seeds, etc) followed by either IMRT or SBRT.
All of these have the same goal but some - and only in some men - have more SE’s than others; usually the higher dose. There is a test (whose name escapes me) to see how you might tolerate higher dose radiation so ask your RO.
ADT is going to give you an extra margin for success, no two ways about it. But how much that is varies from 3-10%, depending on what you read or whom you ask. At age 80, perhaps the actuarial tables would say not to bother since you are already living longer than the average adult male in the US.
But that is an average - not an indicator of YOUR current health status. You’ve indicated that you are in excellent health with no co-morbidities so you have a very good chance of living 10 more years and beyond. So ADT could prevent recurrence in your lifetime.
That said, you could drop dead tomorrow from a heart attack in excellent health…people do die.
So the decision to ‘ADT or not to ADT’ is really a coin toss and how comfortable you are with that decision.
And just to confuse matters more, side effects from ADT vary from person to person SO MUCH, that you cannot predict how you will react. But if you take Orgovyx - an oral form of ADT - you’ll know within 6 weeks or so how much you are affected by it; so you CAN stop it and recover very quickly.
Lupron (and others) is an injection and its effects ‘spike’ soon after and are usually much more pronounced. But it’s now in your system and will take months to wear off. You really don’t want that. Best,
Phil