How to manage hormone therapy side effects?

Question

Hello doctor,

I am a 72-year-old man diagnosed with advanced prostate cancer after experiencing increasing pelvic pain and difficulty walking. My PSA level was initially at 15 ng/mL, and a subsequent MRI (magnetic resonance imaging) revealed bone metastasis, particularly in my hips and spine. A biopsy confirmed the cancer was high-grade with a Gleason score of 9 (4+5), and I was started on androgen deprivation therapy (ADT) to control the hormone-driven growth of the tumor.

While I have noticed some reduction in pain, I am also dealing with side effects like hot flashes, loss of libido, and muscle weakness, which are affecting my quality of life. My doctor has discussed adding chemotherapy with docetaxel, but I am concerned about the additional side effects and my overall ability to tolerate it at my age. Given my advanced cancer and age, what are my options for managing the side effects while trying to extend my life?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understand your concern.

Your diagnosis of advanced prostate cancer with bone metastases and a high Gleason score (9) indicates an aggressive and advanced disease. The primary goal is to control the cancer’s progression, alleviate symptoms, and improve quality of life. Androgen deprivation therapy (ADT) is the treatment for hormone-sensitive prostate cancer, as it reduces tumor growth driven by testosterone. ADT has side effects that impact daily life.

1. Androgen deprivation therapy (ADT):

• It helps slow cancer progression and reduce symptoms such as pelvic pain.

• Side effects: Hot flashes, loss of libido, fatigue, muscle weakness, and bone thinning (osteoporosis) are common.

The side effects can be managed by

Medications.

Lifestyle changes.

Wearing light clothing.

Using cooling devices.

Avoiding spicy foods.

Calcium and vitamin D supplements can reduce fracture risk.

2. Chemotherapy with Docetaxel:

• It improves survival in patients with advanced prostate cancer.

Side effects: fatigue, nausea, hair loss, risk of infection (due to lowered white blood cell counts), and neuropathy are common.

3. Bone-directed therapies:

• Discuss your overall health and ability to tolerate chemotherapy with your oncologist.

• Discuss whether oral androgen receptor-targeted therapies or bone-directed treatments might be appropriate.

I hope this helps.

Thank you.