1. < Prostate Cancer

Proton Therapy or Cyberknife without ADT for Gleason 8?

Posted by undetectable @undetectable, Aug 9, 2023

My husband, 71, G8, PSA 8, PSMA PET no spread, has planned surgery for September. He ruled out radiation options because of required 18-24mos ADT. But after extensive reading about less invasive Proton and Cyberknife procedures, I have nagging doubts.

If you chose one of these options w/ G8, did you also need hormone therapy and if so, for how long?

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ozelli | @ozelli | Aug 11, 2023

Yep, that is a solid 8….

My advice would be not to rush but ultimately it is your decision. The doc at any proton center should be able to assist your decision making.

Best of luck to you whichever path you choose.

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bjroc | @bjroc | Aug 11, 2023

Ozelli is giving great advice here seems like to me. Call Mayo radiation Onc for appt about proton or other proton center. Don't rush to surgery. I have had to learn to slow down myself, my first urologist I went to just for BPH was ready to do surgery on me after he did a biopsy, and was really rushing me I felt like. It is why I switched to Mayo.

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1 reply
undetectable | @undetectable | Aug 11, 2023
In reply to @ozelli "If it were me I would like to see the studies that support the use of..." + (show)
@ozelli

If it were me I would like to see the studies that support the use of adt with those numbers.

I suggest to you that those studies are very hard to find.

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Exactly - studies are few and far between. Just had long talk with a gerontologist friend who is also a G8 PC survivor (had surgery). He said he could find no data about G8 and proton. He also thought my husband would need additional treatment for enlarged prostate. I have contacted two proton centers to ask about the Lupron but the (limited) info I've found on the net says ADT is standard for G8.

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1 reply
undetectable | @undetectable | Aug 11, 2023
In reply to @bjroc "Ozelli is giving great advice here seems like to me. Call Mayo radiation Onc for appt..." + (show)
@bjroc

Ozelli is giving great advice here seems like to me. Call Mayo radiation Onc for appt about proton or other proton center. Don't rush to surgery. I have had to learn to slow down myself, my first urologist I went to just for BPH was ready to do surgery on me after he did a biopsy, and was really rushing me I felt like. It is why I switched to Mayo.

Jump to this post

Not rushing to surgery, but my husband managed to get an appt with a local superstar surgeon . We're in a large city with many options but don't want to give that up. Even one rad oncologist pushed my husband toward surgery because of high risk/aggressive and enlarged prostate.

I started thinking about proton therapy after I saw some success stories on this site and elsewhere on the web. But there seem to be no studies or other data about results for Gleason 8. My husband is adamant about avoiding ADT and has several friends with good RP results (cancer free w/ minimal side effects), with the surgeon he chose. Meanwhile, have reached out to a proton center nearby as well as to Mayo. Will report back.

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undetectable | @undetectable | Aug 11, 2023
In reply to @donaldguy "I’m 74 with two 8 cores and two 9. No spread as per nuclear bone scan,..." + (show)
@donaldguy

I’m 74 with two 8 cores and two 9. No spread as per nuclear bone scan, PET, and MRI. I had robotic surgery at Mayo on 7/10. Also removed lymph nodes, sems, and vans. All were clear as were bladder margins. I feel good about my decision and am recovering nicely and improving continence daily. If I have problems down the road, all radiation options are open. Radiating first basically eliminates future surgery, as I understand it. I can live without a prostate as long as I’m also living without cancer but I realize everyone and every case is different. Praying for you as you work through this decision.

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Looks like this is my husband's decision as well. Good luck to you - hope you're recovering quickly.

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undetectable | @undetectable | Aug 11, 2023
In reply to @undetectable "Exactly - studies are few and far between. Just had long talk with a gerontologist friend..." + (show)
@undetectable

Exactly - studies are few and far between. Just had long talk with a gerontologist friend who is also a G8 PC survivor (had surgery). He said he could find no data about G8 and proton. He also thought my husband would need additional treatment for enlarged prostate. I have contacted two proton centers to ask about the Lupron but the (limited) info I've found on the net says ADT is standard for G8.

Jump to this post

Update: Heard back from one proton center. They would require Lupron and would not be able to treat the enlarged prostate. So it looks like RP is the only option. My husband is ok with this decision and it's a relief to be able to stop my all-night research.

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2 replies
undetectable | @undetectable | Aug 12, 2023

Deleting - duplicate reply

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ozelli | @ozelli | Aug 13, 2023
In reply to @undetectable "Update: Heard back from one proton center. They would require Lupron and would not be able..." + (show)
@undetectable

Update: Heard back from one proton center. They would require Lupron and would not be able to treat the enlarged prostate. So it looks like RP is the only option. My husband is ok with this decision and it's a relief to be able to stop my all-night research.

Jump to this post

I wish you both the best but do a follow-up post if you can after treatment.

Readers here are all in full-blown education mode.

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