Age vs. QOL vs. Prostate Cancer ADT treatment

hungarian

Just to recap my husband’s situation:

Age -77 (relatively healthy)

psa-2.7

Gleason 8-4/4

tc2a

clear bone scan

biopsy 4 out of 14 positive cores

Treatment prescribed:

12 mos monthly Firmagon (instead of Eligard which we requested)

25 radiation beginning after 2 mos of Firmagon

3 Cyberknife sessions

The question is whether his treatment option, although the gold standard, is really necessary because of his age? I guess the question is whether he can eliminate the ADT or perhaps eliminate the 25 radiations. Is it over the top for a man his age? We’ve only had one shot so far but I’m having sleepless nights over whether we made the right choice to put him through all of this. Would appreciate your opinions. Thank you so much!

VascodaGama

Hi again,

The question is whether his treatment option, although the gold standard, is really necessary because of his age?

This is difficult to answer. It all depends on your wishes.

According to NCCN guidelines, those over 75, shouldn't be advised for radical interventions (surgery or radiation) aiming cure. However, healthy patients can try cure at their willingness.

For me, a choice to quality of life is at the top. Treatments involve risks and side effects and none of them warrants cure. Advanced cases where the quality of life is already lost needs prime attention.

Surely you can have radiation treatment without ADT or just control cancer development with ADT on intermittent administration.

Patients with long periods of life expectancy are usually moved to full protocols of treatment. You need a second opinion from a medical oncologist.

https://www.nccn.org/guidelines/guidelines-process/about-nccn-clinical-practice-guidelines

best wishes,

VGama

Old Salt

You asked for opinions. Have you looked at the average life expectancy for a 77-year-old with no comorbidities (?) and good (?) genes. And what do the two of you want to do during those remaining years?

It is possible that, considering his age, your husband won't fully recover from the ADT. How big of a problem will that be?

PS: As I mentioned before in your earlier thread, I underwent a very similar treatment, but I was about five years younger than your husband and recovered OK after 18 months of ADT. Yes, I was often tired, had hot flashes, but I tried to stay active, which is what everyone recommends.

hungarian

Hi Again

So my husband has now had 8 injections of Firmagon. Started 8/2022. Side effects not for n. . 28 Radiation starting on 11/9/22 and then 3 Cyberknife in

hungarian

Back again. 28 doses of radiation completed 12/2022. 3 Cyberknife completed 1/15/2023. 9 firmagon treatments thus far. Side effects are really tough. Severe burning sensation during urination and also burning sensation in lower abdomen constantly. Additionally pretty bad lack of control when urinating which is very frequent. Any advice on how to get relief from side effects? Pretty miserable 4 months post radiation.

Old Salt

Your husband should definitely see a specialist about these issues. I hope (s)he can prescribe something to help with the urination. The burning sensation in the lower abdomen doesn't seem 'normal' to me. Could something else be happening? Do inquire!

PS: I had similar treatment (3xCyberknife + 25xIMRT + 18 months of ADT) but I did not encounter such bad side effects. I was a bit younger at the time (72) which may have helped.

hungarian

Thank you for your prompt reply. Should he see the radiology oncologist that set up his treatment?

Old Salt

That's what I would recommend.