Can my prostate cancer spread to the bones or lymph nodes?

Question

Hello doctor

I am a 64-year-old man whose routine prostate-specific antigen (PSA) test came back elevated at 12.8 ng/mL, up from 4.2 ng/mL last year. My prostate biopsy revealed adenocarcinoma with a Gleason score of seven in six of twelve cores. My magnetic resonance imaging (MRI) showed a 2.5-centimetre lesion with probable extracapsular extension, and the bone scan was negative for metastases.

My PSA density is 0.18 ng/mL/g, and genetic testing revealed that I carry a BRCA2 mutation, which may make this cancer more aggressive. My father died of prostate cancer at the age of seventy-two, and I am weighing treatment options between surgery and radiation. Could this intermediate-risk prostate cancer spread to my bones or lymph nodes, and will treatment affect my ability to have erections or control my bladder permanently?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

It is understandable to be concerned about your condition, especially since you have been diagnosed with prostate cancer and your father also had prostate cancer. In addition, your BRCA2 (breast cancer gene 2) test result is positive, which increases the likelihood of hereditary prostate cancer.

The positive aspect is that your Gleason score indicates intermediate-risk disease, which means the tumour is not considered highly aggressive. A positive BRCA2 result shows a hereditary tendency, but it does not necessarily mean your cancer behaves aggressively; this is determined primarily by the Gleason score and imaging results. So, the possible cause is hereditary prostate cancer.

In your case, radical treatment is recommended rather than active surveillance. Radical treatment options include surgery (radical prostatectomy) or radiotherapy. In many situations like yours, radiotherapy is preferred because the risk of long-term side effects, such as erectile dysfunction, urinary retention, or urinary incontinence, is lower compared to surgery.

The important advantage here is that your cancer has not spread to the lymph nodes or the bones, which means it is still potentially curable with radical radiotherapy. After treatment, we monitor the prostate-specific antigen (PSA) level, and depending on the trend, we may add androgen deprivation therapy (ADT), which is hormonal therapy using medicines such as Leuprolide or Goserelin.

If androgen deprivation therapy is needed, some temporary side effects may occur, including weight gain, decreased libido, and sexual dysfunction. However, these are reversible, and sexual function typically returns once hormonal therapy is discontinued and PSA levels stabilize.

Side effects related to radiotherapy may include a burning sensation during urination or mild bowel disturbances, but these effects are also temporary and usually resolve after the radiotherapy sessions end. Treatment sessions generally range from one to five sessions, depending on the protocol used.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.