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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undetectable | @undetectable | Aug 13, 2023
In reply to @ozelli "I wish you both the best but do a follow-up post if you can after treatment...." + (show)
@ozelli

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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Will do. Surgery scheduled for Sept 7.

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mothergoose1 | @mothergoose1 | Aug 13, 2023

Hi I’m 64 and had radiation therapy for 28 days.. after that I went back for my PSA TEST and it elevated by 26 points.. After I found out about this my Doctor wanted me to start hormonal therapy using Eligard… I did extensive research on this drug and all the other ones that are used for hormonal therapy and I would suggest to you is don’t even go there… If I had to do it all over again I would just do active surveillance period!!!! All these drugs are far to dangerous to take specially for someone with heart trouble… See the attached video

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1 reply
dragonfly757 | @dragonfly757 | Aug 13, 2023
In reply to @mothergoose1 "Hi I’m 64 and had radiation therapy for 28 days.. after that I went back for..." + (show)
@mothergoose1

Hi I’m 64 and had radiation therapy for 28 days.. after that I went back for my PSA TEST and it elevated by 26 points.. After I found out about this my Doctor wanted me to start hormonal therapy using Eligard… I did extensive research on this drug and all the other ones that are used for hormonal therapy and I would suggest to you is don’t even go there… If I had to do it all over again I would just do active surveillance period!!!! All these drugs are far to dangerous to take specially for someone with heart trouble… See the attached video

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Proton therapy is the best option. Sorry your doctor didn't recommend it.

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mikewo | @mikewo | Aug 14, 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.

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Not to add to your decision misery but I am a Gleason 4-3 who did the 5-proton radiation treatment at Mayo. I have a 120-gram prostate and after radiation I feel I am urinating better than before. I am 73 and read that ADT does not make that much difference in men over 70 in my case. I am not sure about Gleason 8. My three-month PSA after radiation was undetectable. I have had no side effects from the radiation other than two five-inch tan circles, one on each hip where the radiation went in. I even messaged the radiation oncologist to be sure thet they gave me enough radiation.

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undetectable | @undetectable | Aug 14, 2023

Wow, congrats. I think it's too late psychologically to change course, but just for curiosity I might call Mayo and find out if no ADT is an option for G8. The proton center in San Diego said it wasn't.

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1 reply
undetectable | @undetectable | Sep 17, 2023

Update: Surgery was last week and so far so good. Very long (6.5 hours) procedure because of enlarged prostate issue, but nerves were spared and doc said he didn't see anything worrisome cancerwise. Husband had very minimal discomfort and zero pain - only took tylenol and Alleve. Walked 1-1.5 miles a day around the house starting first day home, and in general was a happy camper, other than catheter which was yucky. Doc ordered cystogram at post op visit before cath removal and was very happy with recovery. Only minor leaks, fewer each day. Still waiting for pathology report...Fingers crossed!

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undetectable | @undetectable | Sep 17, 2023
In reply to @undetectable "Husband had 9 of 18 positive cores, four 4+4. Waiting for Decipher and second opinion on..." + (show)
@undetectable

Husband had 9 of 18 positive cores, four 4+4. Waiting for Decipher and second opinion on biopsy from JHU, but I doubt this is a 'low 8.' Time is running out - he's feeling ok about the scheduled RP in 3.5 weeks.

I'm trying to find Proton without Lupron studies, not much luck.

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Update: JHU downgraded biopsy slightly, said only two cores were 4+4. Decipher was .61 which is still high risk, but just over the intermediate risk mark. Now that surgery is over, waiting for pathology.

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undetectable | @undetectable | Sep 17, 2023
In reply to @undetectable "Wow, congrats. I think it's too late psychologically to change course, but just for curiosity I..." + (show)
@undetectable

Wow, congrats. I think it's too late psychologically to change course, but just for curiosity I might call Mayo and find out if no ADT is an option for G8. The proton center in San Diego said it wasn't.

Jump to this post

Update: I did contact Mayo and ADT would have been required with the 5 proton treatments - dealbreaker for husband.

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