My father has prostate cancer. Should we explore other options?

Question

Hello doctor,

My father, aged 73, was diagnosed with prostate cancer last month. His prostate-specific antigen (PSA) level was 15.2 nanograms per milliliter (ng/mL), and a prostate biopsy revealed a Gleason score of seven. A bone scan was negative.

The oncologist suggested radiation therapy combined with androgen deprivation. So my questions are -

Are there other effective treatment options we should consider at his age?
What are the likely side effects of hormone therapy, especially regarding bone health and mood?
Should we consider a second opinion on surgery versus radiation?
How often do PSA levels need monitoring during and after therapy to detect recurrence?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for reaching out.

I understand your concern.

Your father’s diagnosis of prostate cancer with a prostate-specific antigen (PSA) level of 15.2 nanograms per milliliter (ng/mL) and a Gleason score of seven places him in the intermediate-risk category. The absence of bone metastasis is encouraging and means the cancer is still in a potentially curable stage.

At 73, external beam radiation therapy combined with androgen deprivation therapy (ADT) is a widely accepted and effective treatment option for such cases. Radical prostatectomy (surgical removal of the prostate) is another option, but it tends to be less favored in older patients due to higher risks of complications and longer recovery times.

Still, seeking a second opinion can help understand the benefits and risks of surgery versus radiation in his specific case. This can empower you to make a more informed decision aligned with his health status and personal preferences.

Androgen deprivation therapy works by suppressing testosterone, which prostate cancer cells depend on to grow and spread. While effective, it does come with potential side effects that can affect quality of life. These include:

Fatigue, hot flashes, and sexual side effects such as erectile dysfunction and loss of libido.
Mood changes, including irritability, depression, or emotional flatness.
Increased risk of bone loss (osteoporosis), as well as metabolic effects like weight gain or insulin resistance.

To counter bone-related risks, doctors often recommend regular bone density monitoring and may suggest calcium, vitamin D, or bone-strengthening medications such as Bisphosphonates or Denosumab. PSA monitoring is typically checked every three to six months during and after treatment.

A steady decline in PSA during therapy is expected, and after treatment, PSA should remain low. A rising PSA after a period of stability may be the first sign of recurrence, so regular follow-up is important for early detection.

Overall, your father’s outlook is good with timely treatment, and staying informed and involved in his care decisions is one of the best ways you can support him.

I hope this information helps you.

Thank you.