Thanks for your query
with gleason score of 8/10 and PSA 20.8 is suggestive of advanced disease and has high probability of distant disease.
Such a disease can be managed by hormonal therapy in the form of LHRH depot injection and bicalutamide
Recently High intensity focussed ultrasound
therapy has been designed for patients meeting your criteria.
are not the first line options in your case.
If you have urinary symptoms, a channel TURP maybe planned.
I hope i have answered your query
Dr Vineet Malhotra