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

@jeffmarc From where I sit, everything I've done so far is a risk. I had different options given to me and settled on the one that seemed to attack the pc with force - early introduction of ADT a month and a half prior to SBRT. After 6 months of ADT and the SBRT, my psa is undetectable. I think it's likely that after 6 or 12 more months of ADT, it will also be undetectable. The trade-off of a return to my usual physical condition vs an additional 6 months of SEs at my age is a difficult decision. I'm still collecting advice from trusted sources and haven't made a decision yet. But I'm sure inclined to stop at 6 months and test after 6 more.

@cadaddy
Since I’ve been on ADT for eight years, the side effects just don’t Affect me like they do Many other people. At least the psychological and fatigue side effects. Yes, you do lose interest in sex but after a while, it just becomes normal. It’s just a matter of exercising to offset the other things that come up.

I understand why you wanna get off it. Hopefully your case is able to be managed without it.

Just something to think about and discuss with your doctor. Nubeqa (Darolutamide) Can be used alone to keep your PSA undetectable because it’s suppresses testosterone‘s ability to work with the cancer. I know a lot of people using it alone. I spent eight months with just Nubeqa And as my testosterone rose, my PSA stayed undetectable. It also has almost no side effects at all. I really don’t notice any and it’s a pretty common experience..

@cadaddy Why go 6 months? Perhaps after 3 might be better since even a small uptick in PSA could alert you to go back on ADT.
This regimen would probably work if you are on Orgovyx (clears faster) but if on Lupron you might have to go the full 6.
Phil

@heavyphil I thought the same thing but my RO said that it's not certain that the Orgovyx effect would be completely gone in 3 month. The test might give a false positive.

@cadaddy Interesting comment about “…early introduction of ADT a month and a half prior to SBRT.”

There have been studies looking into whether it’s preferable to front-load ADT with radiation treatment or backload it. This is a paper titled - “In Prostate Cancer, ADT After RT Better Than Before RT” - that was presented at the American Society for Radiation Oncology (ASTRO) 2020 Annual Meeting —> http://www.medscape.com/viewarticle/940049)

It discusses whether (and why) ADT with (and after) RT leads to better outcomes than ADT well before RT (which is how it is usually given).

It’s always difficult to know which way is best with so much information available.
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For as long as you're on ADT, your PSA should remain undetectable. My medical oncologist compared hormone therapy to training wheels on a bicycle - at some point you have to take them off and see if you can go without them.

@brianjarvis Since the report is from 2020, I wonder if the use of different radiation therapies - SBRT was less available in 2020 - would have affected the result. My oncologist and RO both strongly urged beginning ADT well before radiation treatment. The idea of weakening or shrinking the pc prior to the radiation was convincing to me.

@cadaddy Perhaps. When I was researching treatments during 2018-2020, SBRT (both Cyberknife and TruBeam) was part of that research. (I eventually chose proton radiation in 2021.)

Most long-term studies that are out there are from data collected 10, 15, 20 years ago. For example, this paper that was published just this year comparing SBRT vs brachytherapy (https://pubmed.ncbi.nlm.nih.gov/41739470/), is from data collected during 2010-2018.

I always asked my doctors to show me the study/data showing that this treatment was preferable to that, or was it just their experience/opinion,