Deciding on treatment
I am 77 have a Gleason score of 8 in stage 1 and am told it is very small. My Doctor has advised me that I should start hormone therapy and radiation treatments. I am scheduled for a PET scan in July and they are sending my biopsy out for a decipher test. Have read a lot about side effects with the hormone therapy and am not sure it is worth all the side effects. Seems like it really reduces your quality of life. Doctor said the with both hormone and radiation I would have about 80% chance of remission and with radiation only it was about 70%. My questions are if the hormones only give you 10% more but reduces your quality of life is it really worth it.
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I'm relatively new here but wanted to say, "Welcome, sorry you're here." That said, if it were me, and what you have stated is all the information I had, I wouldn't be able to make an informed decision as to treatment. I would at least need to see a decipher score before any decision. In my case, I jumped on hormone therapy because the biopsy, by itself, indicated likely metastasis. (Gleason 9 / 5+4; PSA30). In your case, I would need to see more indicators of the aggressiveness of the cancer before I could decide. I am just the opposite of you in my concern for side effects. I can stop taking the drugs, I can't undo the radiation.
Anyway, best wishes and more experienced folks will be along shortly.
@cobratk
You still have some really important tests to come back before deciding on treatments. The PET scan will help show if has spread. The Decipher will show aggressiveness of your prostate cancer.
For me I would wait until those tests are known since you are questioning the hormone treatments.
Now my experience with this. Had PSA rising, had MRI (suspicous areas), biopsies with 4+3=7. Diagnosis intermediate risk. Original recommended treatment was radiation with hormone treatments. (R/O Mayo).
R/O send biopsies for Decipher test. Came back low risk not medium risk. PSMA test negative, bone scan negative. R/O changed my treatment recommendation from radiation with hormones to radiation only.
Had second opinion at UFHPTI with sharing medical records with them. They concurred with Mayo diagnosis and recommended treatment but proton radiation not photon.
Thus you can see how important to have all diagnostic test done to give both you and your urologist or R/O all applicable tests before final treatment plans are in place.
If you are in doubt or want to do what most of us on MCC do is second opinions. Most can do with just agreeing to send medical records to the second opinion medical facility.
I agree with @jc76 as the Decipher test gives you a feel for aggressiveness. Deciding on the race against time, being 77 years old and the issues of side effects from androgen deprivation therapy, is a bit of a guess. If it were me, starting at 77, I would avoid the extra therapy, find out if I could get 5 treatments with an MRI guided machine, Elekta Unity or the MRIdian, and evaluate whether I really need anything after that on a quarterly basis. As a layman, I would be pushing multiple doctors so I could understand if that choice made sense and if not, what were the risks vs benefits.
Regarding minimizing ADT side-effects —> At 77y, are you able to engage in rigorous resistance-training exercise?
Here’s a PCRI video discussing this topic: https://m.youtube.com/watch?v=YE61HSAsFb0
Here’s a clinical trial paper with details about the benefits of resistance-training exercise as it relates to ADT side-effects: https://journals.lww.com/acsm-msse/fulltext/2023/04000/resistance_exercise_training_increases_muscle_mass.2.aspx
If you research the data, and can start exercises before starting ADT, as those experts point out, you’ll do well on ADT.
For me (with a localized Gleason 3+4=7; PSA of 7.976; at 65y), that level of resistance-training exercise led to minimal ADT side-effects: just zero libido (but, everything still worked), muscle atrophy, about 30% loss of strength, and very mild “warm” flashes. That was it. Quality of life was good. Yes, that extra 10% was worth it. (I had 28 sessions of proton radiation.)
Good luck!
I had a tiny gleason 8, and did Tulsa Pro. Other than a few weeks in a catheter there were no side effects.
https://connect.mayoclinic.org/discussion/tulsa-pro-initial-experience/
I am 77 and have been on ADT for over eight years. Yes, there are negative aspects to it but normally I have absolutely no problems, If only I didn’t get hot flashes now and then. Yes, I have to take bone strengthers and have to exercise and do weightlifting, But at 77 that really is a good idea. I walk a mile in the morning on a track and another mile in the afternoon. I try to get to the gym three days a week.
There are a lot of benefits to taking ADT, It will stop your cancer from growing and will probably shrink it.
You should take a look at a treatment like Tulsa Pro, It would have a lot less effect on your body, And might shorten your need for ADT to six months, which would be quite easy to tolerate.
Coming up on 4 years taking ADT + Erleada, I'd say the impact on my quality of life is minimal. But everyone responds differently.
One compromise option would be to take Orgovyx pills instead of injections for hormone therapy. If you don't find the side-effects too bad, stay on them; if they're ruining your quality of life, tell the doctor you want to stop, and their effect should wear off fairly quickly (a couple of months?)
Remember that the radiation may also come with side effects.
Best of luck, whatever you choose!
My Doctor said I am not a candidate for SBRT radiation and that he will use IMRT. Not sure what the side effects of IMRT, he wants to give me 28 treatments.
In the U.S., they usually administer SBRT as a short series of 5 high radiation doses, partly because Medicare won't pay for more than 5 sessions of it (at least, that's what I read), while they usually administer IMRT as a longer series of smaller doses.
I'm guessing that might be part of why your doctor is recommending IMRT — they don't want your individual doses to be too big
Here in Canada, I had my SBRT fractionated into 20 lower-dose sessions, just like with IMRT, so it wasn't an issue.
Same here (in Canada) for me. 20 fractions plus 18 months of ADT (Eligard). I was told an extra 5 fractions (up to 25) would include the lymph nodes, but because the testing showed the nodes were clear the doc suggested 20.