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

I just had a conversation with my RO concerning my PSA results post-SBRT w/ADT. I've been taking Orgovyx since early October and was hoping that I'd be near the end of it. My psa was in the undetectable range and I don't have my testosterone results yet. The side effects of the ADT are bearable but there is a distinct difference in the way I feel now compared to pre-ADT. My RO said that given my high-risk pc - no mets and two small lesions in adjacent lymph nodes which were treated with SBRT - the standard recommendation is one full year of ADT. I countered with letting me complete my 6 months of ADT, stop it, and then test my psa in 6 months. He said it was my decision but it's not the standard course of treatment. I'm 80, very active and reasonably fit and the thought of 6 more months of infrequent hot flashes and the tiredness. Does my proposal sound like a mistake?

I don't know since I will be meeting with RO on Wednesday and scheduling the radiation and Orgovyx. Not as concerned about the radiation as much as the Orgovyx.

I did notice that Orgovyx is very expensive.

@cadaddy
What was your Gleason score? That is a major factor in ADT decisions.

Did you have a decipher test? That will tell you how likely you are to have a reoccurrence. A lot of doctors go by that test to decide how long ADT should be given.

I’m 78 and I’ve been on ADT for eight years, you do get used to it?. I am very Fit, Run a mile on the track twice a day and go to the gym three days a week. Being active actually offsets the fatigue.

The hot flashes are something I’ve lived with for a long time. There are a number of solutions for them. I had Depo-provera Shots every three months and that’s pretty much stopped it. A more recent treatment is oxybutynin, Which seems to work quite well for a number of people I’ve heard from.

Score 8, negative. Thanks for encouragement.

@jeffmarc I had one core of 9, one of 8, two of 3, all the rest benign. What I'm trying to understand is the relative risk of either continuing for 6 more months or not. I was told that the "standard" treatment is a year of ADT. I assume that in the best case the SBRT and the ADT eliminated all the identified pc. If some cells remain hidden somewhere and they show up 6 months from now in a new test, wouldn't re-starting the ADT be sufficient to address the recurrence?

@cadaddy
If you can go six months undetectable while on ADT then stopping it is definitely an option you can pursue. You should get blood test every month for a while to make sure it doesn’t come right back.

If you had one core of Gleason nine, you are a Gleason nine. None of the other numbers count the doctors only count the highest number. Because you are a Gleason 9 your cancer is much more aggressive and much more likely to come back. That is why you want to go for one year before stopping ADT. They usually recommend 18 to 24 months with somebody that has a Gleason nine.

There’s some things you don’t mention. Was anything else found in the biopsy? Did you have intraductal, cribriform, Seminal vesicle invasion (SVI). ECE or EPE? If so, your cancer is more aggressive so you want to be on ADT longer.

@cadaddy

I was Gleason 8 and PSA = 11. I had 44 radiation treatments with 4 months of Lupron. I had to stop at 4 months because of severe and terrible side effects which included migraine headaches, 24 hour/day cold sweats from head to toe, brain fog, pain at injection sites, and in bones and joints. It took 6 months for the side effects to even start diminishing and for my testosterone to rise a little (122). Now after 8 months I still have side effects and absolutely no libido or erections at age 83. My PSA has been < 0.01. It seems to be common for side effects and low testosterone to last for 6 months or more. Makes me wonder why they need to give you ADT every 3 months when the dosage lasts for 9 months.

@jeffmarc Nothing else, no SVI. The MRI indicated a possibility of ECE and in fact there were lesions in two adjacent lymph nodes. The nodes were treated with SBRT at the same dosage as the prostate.

@cadaddy
The Gleason nine along with the lymph node problems make it pretty certain that the ADT requirements would be at least one year if not, 18 months. You can cut it short if you believe in taking chances, get monthly PSA test to make sure it doesn’t come back quickly.