Looking for options for 87 year old father with Gleason 9 PCa.

My brother-in-law was 72 when he was diagnosed with prostate cancer G7 in 2008 and he opted for proton treatments in Jacksonville Fl. The prostate cancer was eleiminated because psa went to below 1 , but three years later in 2011, he was diagnosed with an agressive leukemia, and 6 months after diagnosis he was dead.

Up until the day he died on his death bed, he kept insisting and told everyone that it was the proton radiation treatments that caused his leukemia.

Up until he got the leukemia, he was never sick a day in his life, except for the prostate cancer. He was very healthy, took no medications for anything, exercised regulary, ate all natural foods, etc. So was it really the radiation that caused his leukemia? We will never really know, but it sure looked suspicious.

Thousands of people have this treatment and do fine, so who really knows.

Lube - The issue you may run into with dad's diagnosis (Gleason 8-9) is that very few SBRT centers (the 5-day treatment mode) are treating G8 or 9 cases, except in clinical trials. You may be able to find out where these trials are, and may be able to qualify for one, OR maybe you can find a center that will treat him outside the clinical trials.

Many radiation oncologists routinely prescribe hormone therapy for advanced or aggressive cancer patients (and the G8-9 is aggressive), so I'm not sure if dad will be able to dodge that bullet. I'm also not sure if they would treat him if he declines the HT. Good questions to ask the RO.

I'm not sure if there is any data that scientifically shows whether someone dad's age would do better with one form of radiation or the other, but in general the 5-day guys seem to have fewer side effects and complications.

As an aside, has he considered other forms of radiation, such as Low-dose brachytherapy (seeds)? That may be another option, but again I'm no expert, so there may need to be a combination of therapies to gain the best disease control.

You mentioned that as of September, the disease remains contained. There are some docs who would say that at his age it may be just as prudent to do nothing, and only treat what comes, rather than subjecting him to the side effects, however slight, since clinical disease progression may take years yet.

Thats an easy question to answer TA...its" every mans " objection...you are not dead at 87 any more that you are at...er ah what is your age....

Does your Dad want treatment or does his family want him to have tx for him...for themselves...is he feeling pressure...do not be offended...its not like at that age they don't want to make their family happy...he loves you all...if there is a hint that he doesn't want treatment...I would say its time to let him decide...without guilt...just what he wants to do...and give him the gift of his own life...he ain't gonna die or be uncomfortable without treatment any earlier than he would naturally...You really need to think about this...You will know if you have a concerned chat...If on the other hand you are solidly convinced this is what he wants carry on...his medico's imo should have Zero input on this...sorry some times your best friends won't tell you...you posted and asked for input...thats what I just did.... PS I would suggest you allow your Dad to read this post and watch his reaction...this will truth be out...Im trying help in primarily...no one else ... The input from medicos is only in reference to his desire to want or not want treatment...if he wants treatment ...of course their input is crucial... A man needs to be as Invictus says : ' "the captain of his soul"...in all ways and all conditions period. HW...the good...the bad...the ugly...like existence itself...be not fooled...

Full gland cryotherapy, which is what he would require, has a very high probability of lasting incontinence and impotence (if he still cares about that).

Treatment profile and complications associated with cryotherapy for localized prostate cancer

Extended Followup Oncologic Outcome of Randomized Trial Between Cryoablation and External Beam Therapy for Locally Advanced Prostate Cancer (T2c-T3b)

Hormone therapy can be done in many different ways. An orchiectomy has the least side effects of any hormone treatment. He can take some Casodex pills (50-150 mg) every day with 10 mg tamoxifen to prevent gynecomastia. Or he can get a 3-6 month Lupron shot. He can have hormone therapy on and off intermittently too. Keeping up with an exercise regime is important. The hormone therapy alone can keep him going for quite awhile.

If he wants to be more aggressive against the cancer, he can get the radiation therapy I described.

If he wants to be less aggressive, he can wait and only start on the hormone therapy when the pain starts.This will give you some idea of his expected survival if he does nothing (watchful waiting):

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