Are new targeted therapies better for advanced prostate cancer?

Question

Hello doctor,

I am 72 years old. My PSA level came back very high (46), and biopsy confirmed prostate cancer with a Gleason score of 8. Scans showed that it has spread to the lymph nodes. I have started hormone injections, and the doctor said chemotherapy may be needed later.

I feel very tired and also experience hot flashes from the treatment. I am wondering whether any new targeted therapy for prostate cancer works better than hormones. Also, what is the realistic life expectancy at this stage? I want to be prepared and spend quality time with my family.

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

With a PSA (prostate-specific antigen) of 46, a Gleason score of 8, and spread to lymph nodes, your prostate cancer is considered advanced, and starting hormone therapy is the standard first step because it helps slow disease progression and control symptoms. The tiredness and hot flashes you are experiencing are common side effects of hormone treatment.

In recent years, newer targeted hormonal agents such as Abiraterone, Enzalutamide, Apalutamide, and Darolutamide have been shown to work better than standard hormone injections alone, and in many cases, they can be started earlier in the disease course to improve survival. Chemotherapy with Docetaxel is also sometimes added in fit patients, especially when the cancer is more widespread.

Immunotherapy and radioligand therapies like Lutetium-177 prostate-specific membrane antigen are emerging options in selected patients, though availability may depend on where you live. In terms of life expectancy, it varies widely depending on overall health, response to treatment, and how aggressive the cancer is, but many men with node-positive disease who respond well to modern therapies can live for several years, often five or more, especially if the disease remains controlled with treatment.

While the disease is not usually curable at this stage, treatment can help you maintain a good quality of life and spend meaningful time with family. It would be helpful to discuss with your oncologist whether one of the newer targeted hormonal agents could be added to your treatment plan.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.