Do hormone injections for prostate cancer cause tiredness?

Question

Hello doctor,

My father is 74 and was diagnosed with prostate cancer last year. His PSA was 48 ng/mL, and the biopsy showed a Gleason score of 4+3. He completed radiation therapy and is now receiving hormonal treatment with Leuprolide injections.

His PSA has come down to 1.8, but he has been feeling very tired and is experiencing hot flushes. I want to know the following:

Are these normal side effects of the injections, and do they improve with time?
How long does hormonal therapy usually need to be continued after radiation?
Should he start calcium or vitamin D to protect his bones from treatment-related thinning?
Lastly, is there any benefit in adding the newer oral anti-androgen medicines to help keep the cancer controlled for longer?

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

First, I want to reassure you that your father’s progress is very good. His Gleason score of 4+3 places him in the intermediate-risk group. (The Gleason score is a way of grading how aggressive prostate cancer is. Intermediate-risk means the cancer is treatable and not fast-growing.)

His excellent drop in PSA (prostate-specific antigen) also shows that the treatment is working well.

Because of this, our plan is to continue hormonal therapy (Leuprolide) for one to two years. This type of treatment, called ADT - Androgen deprivation therapy, works by lowering male hormones that feed prostate cancer cells. Continuing this therapy ensures that any remaining cancer cells shrink and do not return.

We do not need to add any stronger or second hormonal medicines right now because his cancer type does not require escalation.

However, hormonal therapy can weaken the bones over time, so we should start:

Denosumab or Zoledronic Acid (Zometa): Injections that help prevent osteoporosis (bone thinning).
Calcium + Vitamin D supplements: To keep the bones strong.

For lifestyle:

Light daily exercise, like walking or gentle stretching, is excellent. Heavy workouts are not needed.
A balanced diet with small, regular meals rich in iron and protein (such as eggs, fish, nuts, lentils, and chicken) will support his strength.
Plenty of water is important because hormonal therapy can cause mild dehydration.

Tiredness and hot flushes are very common side effects of Leuprolide. They usually improve with time. Some men also experience mild weight gain or mood changes, but these changes reverse after the hormonal therapy stops.

We will review him again in seven days to ensure he is comfortable and the treatment plan feels manageable.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.