How to manage prostate cancer treatment side effects at 67?

Question

Hello doctor,

My 67-year-old husband was diagnosed with prostate cancer three months ago, and the treatment is affecting both of us as a couple. He started hormone therapy with leuprolide injections, and his prostate-specific antigen (PSA) level has dropped from 24 to 4.2, which is good news. However, the side effects have been terrible. He has no energy, has gained 25 pounds, and has completely lost interest in intimacy.

As his wife, I am trying to be supportive, but I feel like I have lost my partner. He cries frequently, which is so unlike him, and gets angry over small things. The hot flashes he is experiencing are worse than what I went through during menopause. We have not been intimate in four months, and I am struggling with feelings of rejection, even though I understand it is due to the medication.

His oncologist says this treatment might continue for two years, and I honestly do not know how we will make it through this. I am also worried about his bone health, since hormone therapy can lead to osteoporosis. Are there ways to help men cope better with prostate cancer treatment? I need support too, not just as his wife, but as his caregiver.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and understand your concerns.

Prostate cancer treatment, especially hormone therapy like androgen deprivation therapy (ADT), can be incredibly challenging for both the patient and the caregiver. You are not alone in feeling this way, and it is okay to acknowledge how hard this is.

I would like to tell you how to manage the side effects of hormone therapy

Encouraging light exercise, such as walking or swimming, to combat fatigue and help maintain muscle mass, even 20 to 30 minutes daily, can make a difference.

ADT can cause severe emotional changes due to testosterone suppression. Counseling (individual or couples) or a support group (through organizations like us, too, or the Prostate Cancer Foundation) can be helpful. Consider asking his doctor about antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) like Escitalopram, which can improve irritability and low mood.

Non-drug options include using cool towels, wearing layered clothing, and avoiding triggers such as spicy foods and caffeine.

Calcium and vitamin D supplements are important if levels are low. Weight-bearing exercises like walking or resistance training can help slow bone loss. Also, ask his doctor about bone-density scans like dual-energy X-ray absorptiometry (DEXA).

Loss of libido or erections is physiological, not personal. ADT suppresses testosterone, which significantly reduces sexual desire. Explore non-sexual forms of intimacy such as cuddling, massage, or simply spending quality time together. If he is open to it, consider asking his doctor about low-dose testosterone patches or gels, though this must be carefully weighed due to cancer-related risks.

ADT is often administered for one to three years, but some men are able to take breaks referred to as "intermittent ADT" if their prostate-specific antigen (PSA) levels remain low. Ask his doctor if this might be an option in the future.

I hope this helps.

Thank you.